The results of the FAME II Trial were presented at the 2012 Transcatheter Cardiovascular Therapeutics (TCT) meeting. The study showed the cost effectveness of fractional-flow reserve (FFR) therapy vs. standard medical therapy.

Diagnostic and Interventional Cardiology Editor Dave Fornell shares his choices of the latest advances in cardiac ultrasound from the show floor of the American Society of Echocardiography (ASE) 2012. With the increasing use of more complex interventional procedures, transesophageal echo (TEE) and intracardiac echo (ICE) are being used for guidance to reduce fluoroscopic radiation dose.

To help hospitals upgrade their electrophysiology (EP) reporting systems and integrate EP into cardiovascular and hospital reporting systems, Michael Mirro, M.D., FACC, medical director, cardiology/electrophysiology, Parkview Physicians Group, Ft. Wayne, Ind., offers suggestions of what to look for in systems. He spoke about cardiovascular/EP IT integration and the impact of healthcare reforms during the Heart Rhythm Society (HRS) 2012 scientific sessions.

Diagnostic and Interventional Cardiology Editor Dave Fornell shows some of the most innovative new technology displayed on the show floor at the Heart Rhythm Society (HRS) annual scientific sessions. The tour includes new devices and trends in electrophysiology. For more information: www.DIcardiology.com

Pivitol trial data regarding the safety and efficacy of the Cameron Health Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) system was very positive. The system is currently pending FDA approval and would be the only subcutaneous lead electrophysiology device cleared for use in the United States. The system eliminates the need for venous leads and intra-cardiac securement, greatly simplifying the implant procedure. Data from Cameron Health's IDE trial was presented by Martin Burke, DO, FACC, FACOI, FRCP, director, Heart Rhythm Center, University of Chicago, at the Heart Rhythm Society (HRS) 2012 scientific sessions. For more information: www.DIcardiology.com 

The ACRIN-PA trial showed computed tomography (CT) coronary angiography can be more cost-effective than the standard-of-care in evaluating patients with chest pain in the emergency department. The data was presented by Harold Litt, M.D., during the American College of Cardiology (ACC) 2012 scientific sessions. For more information: www.DIcardiology.com

Related ACRIN-PA Study Content:

VIDEO: CT for Chest Pain Evaluation in The Emergency Department — Interview with Harold Litt, M.D.

VIDEO: ACRIN-PA Trial Showed Benefit of CT in Assessing Chest Pain — Litt explaining the trial.

Coronary CT Angiography is Effective to Evaluate Chest Pain Patients
 

One of the most interesting educational exhibits at the recent American College of Cardiology (ACC) 2012 Scientific Session was "The Heart of Innovation" display on the show floor. The ACC in collaboration with marquee sponsor Philips Healthcare and several other industry leaders created this non-accredited, hands-on education experience. The exhibit explored the evolution of the standard-of-care for heart disease and heart failure caused by valvular disease. It looked at these issues through the lenses of personalized medicine, techno-biology, minimally invasive procedures and physician-patient engagement. The exhibit included technology from the past, present and future of healthcare. To incorporate a historical view, the entrance to the display included the ACC's special collection of historic artifacts encompassing medical books, stethoscopes and device technology dating back hundreds of years, including a stethoscope from 1535. This historical perspective was juxtaposed with a modern attendee experience that included the option to explore the entire exhibit with a specially provided iPad tour. The centerpiece was a mockup of a hybrid OR. It included a Corindus CorPath robotic cath lab intervention guidance system. Other partners included Maquet, showing a portable heart-lung machine the size of a small suitcase and the CFI Medical Solutions ZeroGravity radiation protection system. What made the hybrid OR particularly unique was that it was situated across from the Minimally Invasive Gallery, which featured many of the innovations that are driving procedures performed in the hybrid OR. The gallery encompassed solutions from Medtronic and Edwards Lifesciences, including Edward's breakthrough Sapien transcatheter heart valve. The display discussed current treatments and what the future technologies will likely be from the standard-of-care in the future.

Siemens' AcuNav V 3-D intracardiac echo (ICE) catheter offers detailed, live 3-D images of the interior of the heart. This video shows an example of the catheter imaging the pulmonary vein. The technology may play a role in better guiding transcatheter electrophysiology (EP) ablation procedures. The technology was shown as a work-in-progress during ACC 2012.

Diagnostic and Interventional Cardiology Editor Dave Fornell discusses trends and shares his choices of the most innovative technologies shown on the floor of the American College of Cardiology (ACC) 2012 Scientific Session, held March 24-27 in Chicago.

A couple of key trends were evident on the show floor included:

   • New technology to support trans-aortic valve replacement (TAVR);

   • Launch of new cardiovascular image and information systems (CVIS) to support healthcare's adoption of proposed Stage 2 meaningful use (MU) requirements;

   • Balloon-inflatable TAVR/EVAR introducer sheath;

   • 3-D intra-cardiac echo;

   • Mobile angiography system for hybrid ORs;

   • Chocolate for heart health.

For more information: www.DIcardiology.com

New evidence shows that with appropriate preparation, angioplasty can be safely and effectively performed at community hospitals without on-site cardiac surgery units. This was according to data presented from the CPORT-E trial during the American College of Cardiology (ACC) 2012 Annual Scientific Session. The study is the first randomized controlled trial to investigate elective cath lab angioplasty (or percutaneous coronary intervention, which includes stenting and balloon angioplasty) in community hospitals in the United States.

Results showed no difference in death rates among patients undergoing elective angioplasty at facilities with and without on-site cardiac surgery units. There were also no significant differences in rates of complications such as bleeding, renal failure and stroke.

"The study shows that under certain circumstances, non-primary angioplasty can be performed safely and effectively at hospitals without on-site cardiac surgery," said Thomas Aversano, M.D., associate professor of cardiology at Johns Hopkins University and the study's lead investigator.

Until a recent guideline change by the American College of Cardiology and the American Heart Association, community hospitals without cardiac surgery units performed only emergency angioplasties. Patients needing elective angioplasty were transferred to facilities with on-site cardiac surgery units.

"The study supports and reinforces the [new] guidelines," said Aversano, adding that the findings can help hospitals and healthcare planners more efficiently allocate financial and human resources. The ability for community hospitals to offer elective angioplasty benefits patients, Aversano said. Other studies have shown that patients are often reluctant to transfer to a hospital that may be farther away or more expensive than their community hospital. "It's not just a question of patient convenience — it's also a question of access," he said.

Read the article On-Site Cardiac Surgery Not Required for Safe, Effective PCI
 

Toshiba (Canon) unveiled its Aplio 500 ultrasound system at RSNA 2011, , which offers a unique 3-D fly-through imaging capability. The system takes the image dataset and processes it to create a cine loop fly-through of any hollow, fluid-filled blood vessel, duct or organ. The example in this video is of a blood vessel in the liver. The capability and image quality is similar to what is seen in a virtual colonoscopy created from CT datasets. The technology was highlighted in our editor's choice for most innovative new technologies at RSNA 2011. The future applications of this technology may include 3-D ultrasound navigation aids for vessels in the cath lab.

Society of Nuclear Medicine (SNM) President George Segall, M.D., chief of the nuclear medicine service at the VA Palo Alto Health Care System, and is a professor of radiology and professor of cardiology (by courtesy) at Stanford University School of Medicine, offers insights into the trends he saw at the society's 2011 annual meeting.

Trends in nuclear imaging include the creation of PET/MRI systems, use of time of flight (TOF) imaging, new technqiues to image amyloid plaque in Alzheimer's Disease, and the movement toward multimodlaity imaging rather than radiologists specializing in justy one modality.

More nuclear medicine news and video 

The RIVAL Trial, the largest randomized trial to compare radial access and femoral access for coronary angiography and intervention, researchers found radial access reduced rates of vascular complications, according to research presented at the American College of Cardiology (ACC) 2011 Scientific Session in New Orleans.[1] The trial also found that radial access did not reduce the primary outcome measure of death, heart attack, stroke and non-CABG-related major bleeding compared to femoral access in the overall study population. The data showed these outcomes were equal for both femoral and radial access procedures.

"Interventional cardiologists can feel reassured both radial and femoral approaches are safe and effective," said Sanjit Jolly, M.D., M.Sc., assistant professor of medicine at McMaster University in Hamilton, Ontario, Canada. Radial access did lead to reductions in the primary outcome measure in patients who underwent the procedure at hospitals that conducted a high volume of radial procedures. For centers that were less experienced with radial access, Jolly said it was clear there is a learning curve, and operators got better and faster with radial procedures with more experience. "The take-home message is practice makes perfect," he said. Jolly explained the high-volume centers using radial access performed very well, but it was clear from the study operators need a lot of radial cases to increase performance.

Read the article RIVAL Trial: Radial Access Reduces Vascular Complications
 

Reference:

1.    Jolly SS, Yusuf S, Cairns J, Kari Niemelä DX, Petr Widimsky, Andrzej Budaj, Matti Niemelä, Vicent Valentin, Basil S Lewis,, Alvaro Avezum PGS, Sunil V Rao, Peggy Gao, Rizwan Afzal, Campbell D Joyner, Susan Chrolavicius, Shamir R Mehta, for the group. “Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial.” Lancet 2011. DOI:https://doi.org/10.1016/S0140-6736(11)60404-2