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
VIDEO: Patient Case of Complex High-risk, Indicated PCI With Hemodynamic Support
Behnam Tehrani, M.D., FSCAI, director of the cardiac cath lab, INOVA Heart and Vascular Institute, Fairfax, Va., discusses a complex, high-risk percutaneous coronary intervention (PCI) case where hemodynamic support from an Abiomed Impella device is used to support the patient.
Visit ProtectedPCI.com for more video cases. The website also has additional information on protocols for protected PCI and cardiogenic shock hemodynamic support.
Heart Rhythm Society (HRS) President-Elect Hugh Calkins, M.D., FACC, director, cardiac arrhythmia services and EP lab, Johns Hopkins University, Baltimore, Md., offers an overview of trends and top news in electrophysiology at the HRS 2012 scientific sessions. 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
Implantable cardioverter defibrillators (ICDs) are safe in patients who participate in sports, according to a study presented during Heart Rhythm Society (HRS) 2012. Rachel Lampert, M.D., associate professor of medicine, section of cardiovascular medicine, Yale School of Medicine, explains the study findings during a press briefing at HRS. 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 during the American College of Cardiology (ACC) 2012 scientific sessions. For more information: www.DIcardiology.com
New data from the PARTNER trial for the Edwards Sapien Valve were presented during the American College of Cardiology (ACC) 2012 scientific sessions. The new information included two-year clinical and echocardiographic outcomes after transcatheter vs. surgical aortic valve replacement in high-risk surgical patients. For more information: www.DIcardiology.com
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 left atrial appendage (LAA). The technology may play a role in guiding and properly seating transcatheter LAA occluders. The technology was shown as a work-in-progress during ACC 2012.
Several interventional cardiology experts share their views on how fractional flow reserve (FFR) and optical coherence tomography (OCT) have changed their clinical practice. Increased accuracy and understanding of vessel lesion hemodynamics is cited as a way to better patient outcomes and lower healthcare costs.
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.
The Crux inferior vena cava (IVC) filter was designed for easy deployment and later retrival. This video clip shows deployment of the device, which has has radio-opaque markets for easier visualization under angiography. IVC filters are designed for the prevention of pulmonary embolism.
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 a transseptal puncture. This new ICE technology may help better guide these punctures, which are routinely used in catheter ablations and transcatheter left atrial appendage (LAA) occluder delivery. The technology was shown as a work-in-progress during ACC 2012.
The Crux inferior vena cava (IVC) filter was designed for easy deployment and later retrieval. This video clip shows retrieval of the device, which has has radio-opaque markets for easier visualization under angiography. IVC filters are designed for the prevention of pulmonary embolism.
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 function of the aortic valve. 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 — new technology to support trans-aortic valve replacement (TAVR) and the launch of new cardiovascular image and information systems (CVIS) to support healthcare's adoption of proposed Stage 2 meaningful use (MU) requirements. Other highlights include a balloon-inflatable TAVR/EVAR introducer sheath, 3-D intra-cardiac echo, a mobile angiography system for hybrid ORs and chocolate for heart health. For more information: www.DIcardiology.com
During the American College of Cardiology (ACC) 2012 Scientific Session, McKesson displayed new features for its cardiovascular information system (CVIS). These included an electrophysiology (EP) reporting workflow, the addition of stress and Holter support and integrated inventory management. The features were shown as works-in-progress as part of the upcoming release of McKesson Cardiology v13.0, slated for release by early summer 2012. The EP reporting module integrates diagnostics including tilt tables, implantable devices and ablation treatment EP recording systems. For more information: www.allaboutCVIS.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.
For more information: www.DIcardiology.com
This video, provided by Boston Scientific, shows how to implant the subcutaneous implantable cardioverter defibrillator (S-ICD) system. Unlike conventional implantable cardioverter defibrillators (ICDs), which require thin, insulated wires (leads) to pass through the venous system and into the heart, the entire S-ICD System sits just below the skin and leaves the heart and blood vessels untouched. This technology has the potential to expand the reach of ICD therapy, offering physicians and appropriate patients a new alternative to traditional ICDs. Read the most recent article on the S-ICD — “FDA Clears MRI-safe Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) System.”
DAIC editor Dave Fornell explains some of the most innovative cardiovascular imaging technologies showcased by vendors at the Radiological Society of North America (RSNA) meeting in December 2011.
At RSNA 2011, McKesson shared case studies about its CVIS end-users, who are enjoying new features that increase efficiencies and save time.
At RSNA 2011, Toshiba unveiled its Aplio 500 ultrasound system, 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.
The Miracor Picso Impulse system is supposed to prevent reperfusion injury and the no-flow phenomenon following percutaneous coronary intervention (PCI) by increasing the microcirculation in the ischemic area. The device uses a balloon catheter in the coronary sinus to temporarily increase venous blood pressure.
Paramedics in Bellingham, Wash., used the Lucas device on patient Nancy Olson, who went into cardiac arrest following a heart attack. The device provided chest compressions while she was enroute to the hospital, helping to perfuse her brain and other organs, prior to her undergoing emergency percutaneous coronery intervention (PCI). For more information on the Lucas, visit www.physio-control.com.
Three companies showed different versions of a combined positron emission tomography (PET)/magnetic resonance (MR) system during the Society of Nuclear Medicine (SNM) 2011 annual meeting in San Antonio, Texas. Representatives from Siemens, Philips and GE Healthcare explain how their systems work and how PET/MR may be used as a new modality to show both physiologic and anatomical information.
MIM Software offers remote viewing software to call up diagnostic-quality medical images on an iPad, iPhone and other smart phones. The software, images and computing power are hosted on a cloud-based server, which can be accessed with these devices from any location. MIM Chief Technology Officer Mark Cain demonstrates the system during the Society of Nuclear Medicine (SNM) 2011 annual meeting.
Society of Nuclear Medicine (SNM) President George Segall, M.D., offers insights into the trends he saw at the society's 2011 annual meeting, including PET/MRI and amyloid plaque imaging.
This podcast explains how syngo Dynamics can be used to integrate cardiac imaging picture archiving and communication (PACS) and cardiology reporting systems into one platform.
Experts at The Heart Hospital Baylor Plano explain how integration of the radiology and cardiology PACS can be seamless. They explain how they made this transition at their hospital.
The American College of Cardiology (ACC) 2011 Scientific Symposia offered information on the latest advances in pharmaceuticals, imaging, devices and the services in cardiology. The ACC.11 Expo featured innovative cardiovascular products and services from more than 300 exhibiting companies.
Horizon Cardiology provides solutions to some of the challenges encountered by clinicians today, particularly to improve workflow. It provides improved interfacing, eliminates redundancies and gives clinicians the information they need to perform at maximum efficiency. Other improvements to workflow efficiencies include the charge manager, as well as improving the flow of information from the cath lab. McKesson also has been experimenting with development of an interface for the iPad. For more information: www.AllAboutCVIS.com
Death rates are similar at one year for a catheter-based aortic valve replacement procedure and conventional surgery in older high-risk patients. Results from Cohort A of the PARTNER trial found that survival of patients treated with the Edwards Sapien transcatheter aortic valve was equivalent to those treated with surgical aortic valve replacement in the head-to-head comparison.
The data were presented at the American College of Cardiology's (ACC) 2011 Scientific Session in New Orleans.
For more details, read the article at www.dicardiology.net//article/transcatheter-valve-equals-surgical-outcomes-one-year
In 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. 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. To read more, visit www.dicardiology.net/article/rival-trial-radial-access-reduces-vascular-complications
WomenHeart is the only national organization dedicated to promoting women's heart health through advocacy, education and patient support. As the leading voice for the 42 million American women living with or at risk of heart disease, WomenHeart advocates for equal access to quality care and provides information and resources to help women take charge of their heart health. Lise Tate, CAE, CEO of WomenHeart, the National Coalition for Women With Heart Disease, said the non-profit group helps set up hospital support groups to guide women through their treatment and recovery. Since its inception, WomenHeart — founded by three women heart attack survivors who transformed the isolation, confusion and ignorance about women's heart disease into a rallying call to save women's lives — has been at the forefront of providing support services to women with heart disease and educating policymakers, health professionals and the public about the urgent need to make women's heart health a priority.
Founded in 1999, WomenHeart's mission is to improve the health and quality of life of women living with or at risk of heart disease. Through our programs and services, WomenHeart raises awareness about the importance of prevention and early detection, accurate diagnosis and proper treatment of women's heart disease. WomenHeart is a coalition and a community of thousands of members nationwide, including women heart patients and their families, physicians, health advocates and consumers committed to helping women live longer, healthier lives. At the center of the organization are the more than 500 WomenHeart Champions, all heart disease survivors, who have graduated from WomenHeart's Science and Leadership Symposium at the Mayo Clinic. These alumnae serve as WomenHeart local support group leaders, community educators, media spokeswomen, and general support volunteers. Through leadership and advocacy training, information resources and an online community, WomenHeart empowers women living with heart disease to manage their own heart health and to help all women take charge of their heart health.
For more information: www.womenheart.org
Horizon Cardiology, a cardiovascular information solution (CVIS) from McKesson, enables improved quality of care, a boost in efficiencies and reduced costs while increasing physician and staff satisfaction. The systemâ??s parallel workflows are the key to improving the adoption rate of structured data reporting for echocardiography, vascular ultrasound, nuclear cardiology, cardiac and peripheral catheterization, and ECG management. In addition, McKesson provides a fully integrated hemodynamics monitoring system that populates the cardiovascular record without the need for interfaces. The design of Horizon Cardiology brings the workstation to the clinician through the Web, while the robust architecture is designed with business continuity for good uptime and server virtualization for decreased operating costs. The latest release of Horizon Cardiology has extended the echocardiography module to include congenital reporting. This module includes new features that allow you to compare multiple Z-scores, graphically trend measurements, carry previous report information forward and much more. Error-prone and time-consuming steps in the charge process can be eliminated with Horizon Cardiology Charge Manager. Rather than requiring multiple staff members to re-enter data into multiple systems for every procedure, this charge capture solution makes it possible to enter procedural data once, in a single system. As part of the Charge Manager workflow, the system instantaneously generates a charge audit worklist, simultaneously displays charges and reports on the same screen and supports technical and professional interfaces. Horizon Cardiology includes fully integrated support for fractional flow reserve (FFR), automatically capturing results in a physicianâ??s report. This helps eliminate the time and errors associated with manual data entry and ensures critical data is instantaneously available for review. This integrated FFR is designed to work within an existing infrastructure, eliminating dedicated FFR equipment and offering an immediate return on investment. For more information: www.AllAboutCVIS.com
Vital Images' Vitrea Enterprise Suite 1.3 advanced visualization software offers new cardiac analysis applications and workflow features. Analysis tools include pediatric multi-chamber cardiac analysis, an edge-detecting contour editing tool and a vessel wall feature for efficient vessel navigation in any CT angiography scan. Workflow features include ubiquitous report editing, DICOM print capability from any thin client server and a "save as" feature that allows images to be saved and exported to any computer on the network.
Vital Images is a leader in advanced visualization solutions worldwide, partnering with several leading companies. Its technology is available anywhere, anytime, on the cloud, an iPad, laptop computer, in the home or office.
At RSNA 2010, the company introduced new solutions focusing on advanced clinical functionality, new workflows and oncology. It unveiled new clinical features available on the Vitrea Enterprise Suite 6.0, rolling out eight different new applications. They include software that does de-noising, or low-dose imaging, to complement what computed tomography (CT) scanners are doing to reduce dose. Vital Images' post-processing software takes that process to a deeper level.
ther new clinical functionalities introduced at RSNA include adding advanced magnetic resonance (MR) funtionality to the platform and new functionality around fusion oncology.
In addition, the company notes that its technology is VMware-certified, or virtualized, which can save users money on the back end. The company also has been recognized for its product service and support.
For more information: www.vitalimages.com
Two applications will help clinicians perform interventions with confidence and accuracy.
Innova Vision dynamically overlays 2-D fluoroscopic images with 3-D models from multiple modalities. The 3-D imaging offers excellent image quality and provides the relevant information required during complex procedures. The fused roadmapping display allows clinicians to advance guidewires, catheters, coils and other devices by visualizing them with a real-time 3-D model.
Innova TrackVision facilitates the performance of accurate needle-based guided interventions. This feature is used in combination with Innova CT.
3-D CT images are acquired and automatically transferred and reconstructed at the Advantage workstation. Images are displayed on a dedicated monitor in the procedure room, and image manipulation tools are available on the Innova 3-D mouse. Innova TrackVision is used with Innova Trajectory Planning, a protocol that optimizes and defines the needle trajectory needed for interventions.
For more information: www.gehealthcare.com
Infinitt's picture archiving and communication systems (PACS) offer an affordable medical imaging and information solution to numerous specialties. The company has systems designed specifically for radiology, cardiology, mammography, radiation therapy, dental PACS, advanced visualization, radiology information systems (RIS), teleradiology and ophthalmology. Infinitt systems are installed in more than 2,000 hospitals world-wide.