Publications by authors named "Karthik Ananthasubramaniam"

63 Publications

All that glitters is not sarcoidosis: Importance of systematic review of F-FDG-PET data and integration of clinical information.

J Nucl Cardiol 2022 Apr 11. Epub 2022 Apr 11.

Heart and Vascular Institute, Henry Ford West Bloomfield Hospital, 6777 W Maple, West Bloomfield, MI, 48322, USA.

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http://dx.doi.org/10.1007/s12350-022-02956-zDOI Listing
April 2022

Can we "REFINE" the art of predicting ischemia on SPECT myocardial perfusion imaging?

J Nucl Cardiol 2021 Dec 6. Epub 2021 Dec 6.

Department of Nuclear Medicine, Manchester University, Manchester, United Kingdom.

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http://dx.doi.org/10.1007/s12350-021-02867-5DOI Listing
December 2021

Cardiac PET in aortic stenosis: Potential role in risk refinement?

J Nucl Cardiol 2021 Jul 6. Epub 2021 Jul 6.

Department of Internal Medicine, Heart and Vascular Institute, Henry Ford West Bloomfield Hospital, West Bloomfield, MI, USA.

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http://dx.doi.org/10.1007/s12350-021-02714-7DOI Listing
July 2021

No shortcuts with left bundle branch block and myocardial perfusion imaging: Lesson learnt with dobutamine cardiac PET.

J Nucl Cardiol 2022 Feb 6;29(1):230-234. Epub 2021 May 6.

Heart and Vascular Institute, Henry Ford West Bloomfield Hospital, 6777 West Maple, West Bloomfield, MI, 48322, USA.

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http://dx.doi.org/10.1007/s12350-021-02640-8DOI Listing
February 2022

Gated SPECT left ventricular shape and prediction of super responders to cardiac resynchronization therapy: Not so easy as it (LV) looks.

J Nucl Cardiol 2021 Feb 19. Epub 2021 Feb 19.

Heart and Vascular Institute, Henry Ford West Bloomfield Hospital, 6777 West Maple, West Bloomfield, MI, 48322, USA.

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http://dx.doi.org/10.1007/s12350-021-02548-3DOI Listing
February 2021

Ghost Catheter Fibrin Sleeve: Case Report and Literature Review.

CASE (Phila) 2020 Oct 19;4(5):405-409. Epub 2020 Jun 19.

Heart and Vascular Institute, Henry Ford West Bloomfield Hospital, West Bloomfield, Michigan.

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http://dx.doi.org/10.1016/j.case.2020.05.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581608PMC
October 2020

Review of ultrasound contrast agents in current clinical practice with special focus on DEFINITY in cardiac imaging.

Future Cardiol 2021 03 8;17(2):197-214. Epub 2020 Sep 8.

Heart Vascular Institute, Henry Ford West Bloomfield Hospital, West Bloomfield, MI 48322, USA.

Echocardiography is the most widely used noninvasive modality to evaluate the structure and function of the cardiac muscle in daily practice. However, up to 15-20% of echocardiograms are considered suboptimal. To enable accurate assessment of cardiac function and wall motion abnormality, the use of ultrasound microbubble contrast has shown substantial benefits in cases of salvaging nondiagnostic studies and enhancing the diagnostic accuracy in daily practice. DEFINITY is a perflutren based, lipid shelled microbubble contrast agent, which is US FDA approved for left ventricular opacification. The basis of ultrasound microbubbles, its development, and the clinical role of DEFINITY (characteristics, indications and case examples, side effect profile and existing evidence) is the subject of discussion in this review.
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http://dx.doi.org/10.2217/fca-2020-0049DOI Listing
March 2021

A Review of Selected Adult Congenital Heart Diseases Encountered in Daily Practice.

Curr Cardiol Rev 2021 ;17(3):260-278

Heart And Vascular Institute, Henry Ford West Bloomfield Hospital, West Bloomfield, MI 48322, United States.

The advancement in corrective surgical procedures and anaesthesia technology has resulted in the increased survival of patients with Congenital Heart Diseases (CHD). Most of the surviving CHD patients have successfully reached adulthood and those surviving adults now outnumber the infants born with the CHD. Unfortunately, the surviving adults with CHD do not get proper care due to either inconsistent follow-up or not getting care from a specialist in the field of CHD. It is imperative for general practicing clinicians to be aware of the congenital diseases as well as the current clinical recommendations. This manuscript reviews some of the common congenital diseases seen in adults such as cardiac shunts, left heart obstructive lesions, and aortopathies.
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http://dx.doi.org/10.2174/1573403X16666200810104615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8640859PMC
July 2021

Loeffler's Endocarditis and Hypereosinophilic Syndrome.

Cardiol Rev 2021 May-Jun 01;29(3):150-155

The Heart and Vascular Institute, Henry Ford West Bloomfield Hospital, West Bloomfield, MI.

Loeffler's endocarditis and hypereosinophilic syndromes are a unique group of infiltrative disorders characterized by hypereosinophilia, inflammatory thrombotic, and ultimately, fibrotic involvement of the heart leading to multiple complications including valve involvement, thromboembolic phenomena, heart failure. Clinical recognition, comprehensive laboratory and multimodality imaging diagnostic workup, and early initiation of treatment have been shown to slow down the progression and promote remission. This review addresses a detailed analysis of Loeffler's endocarditis and hypereosinophilic syndromes.
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http://dx.doi.org/10.1097/CRD.0000000000000324DOI Listing
October 2021

ASNC Image Guide Registry: Leading the way toward improving quality and patient care in nuclear cardiology.

J Nucl Cardiol 2022 Feb 11;29(1):177-180. Epub 2020 May 11.

Henry Ford West Bloomfield Hospital, Heart and Vascular Institute, West Bloomfield, MI, 48322, USA.

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http://dx.doi.org/10.1007/s12350-020-02163-8DOI Listing
February 2022

Interpreting technetium-99m pyrophosphate cardiac scans to diagnose transthyretin cardiac amyloidosis: Need for due diligence.

J Nucl Cardiol 2021 Aug 10;28(4):1798-1801. Epub 2020 May 10.

Heart and Vascular Institute, Henry Ford West Bloomfield Hospital, 6777 West Maple, West Bloomfield, MI, 48322, USA.

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http://dx.doi.org/10.1007/s12350-020-02181-6DOI Listing
August 2021

Quantitative Rb dynamic pet perfusion analysis with kinetic modeling for myocardial viability: Can we get away with just Rb perfusion kinetics?

J Nucl Cardiol 2019 04 26;26(2):387-390. Epub 2019 Feb 26.

Nuclear Medicine Centre, Manchester Royal Infirmary, Manchester, UK.

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http://dx.doi.org/10.1007/s12350-019-01616-zDOI Listing
April 2019

Progressive Left Ventricular Hypertrophy after Heart Transplantation: Insights and Mechanisms Suggested by Multimodal Images.

Tex Heart Inst J 2016 Feb 1;43(1):65-8. Epub 2016 Feb 1.

Immunosuppression is the typical measure to prevent rejection after heart transplantation. Although rejection is the usual cause of cardiac hypertrophy, numerous other factors warrant consideration. Calcineurin inhibitors rarely cause hypertrophic cardiomyopathy; the few relevant reports have described children after orthotopic kidney or liver transplantation. We present the case of a 73-year-old woman, an asymptomatic orthotopic heart transplantation patient, in whom chronic immunosuppression with prednisone and cyclosporine apparently caused a phenotype of hypertrophic cardiomyopathy. The natural course of her midapical hypertrophy was revealed by single-photon-emission computed tomography, positron-emission tomography, and 2-dimensional echocardiography. Clinicians and radiographers should be alert to progressive left ventricular hypertrophy and various perfusion patterns in heart transplantation patients even in the absence of underlying coronary artery disease. Toward this end, we recommend that advanced imaging methods be used to their fullest extent.
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http://dx.doi.org/10.14503/THIJ-14-4657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810589PMC
February 2016

Guiding coronary revascularization using PET stress myocardial perfusion imaging: The proof is in the pudding.

J Nucl Cardiol 2017 06 31;24(3):975-979. Epub 2016 Mar 31.

Heart and Vascular Institute, Henry Ford Hospital, 2799 West Grand Blvd, K-14, Detroit, MI, 48202, USA.

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http://dx.doi.org/10.1007/s12350-016-0479-2DOI Listing
June 2017

Midventricular Hypertrophic Cardiomyopathy with Apical Aneurysm: Potential for Underdiagnosis and Value of Multimodality Imaging.

Case Rep Cardiol 2016 20;2016:9717948. Epub 2016 Jan 20.

Heart and Vascular Institute, Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI 48322, USA.

We illustrate a case of midventricle obstructive HCM and apical aneurysm diagnosed with appropriate use of multimodality imaging. A 75-year-old African American woman presented with a 3-day history of chest pain and dyspnea with elevated troponins. Her electrocardiogram showed sinus rhythm, left atrial enlargement, left ventricular hypertrophy, prolonged QT, and occasional ectopy. After medical therapy optimization, she underwent coronary angiography for an initial diagnosis of non-ST segment elevation myocardial infarction. Her coronaries were unremarkable for significant disease but her left ventriculogram showed hyperdynamic contractility of the midportion of the ventricle along with a large dyskinetic aneurysmal apical sac. A subsequent transthoracic echocardiogram provided poor visualization of the apical region of the ventricle but contrast enhancement identified an aneurysmal pouch distal to the midventricular obstruction. To further clarify the diagnosis, cardiac magnetic resonance imaging with contrast was performed confirming the diagnosis of midventricular hypertrophic cardiomyopathy with apical aneurysm and fibrosis consistent with apical scar on delayed enhancement. The patient was medically treated and subsequently underwent elective implantable defibrillator placement in the ensuing months for recurrent nonsustained ventricular tachycardia and was initiated on prophylactic oral anticoagulation with warfarin for thromboembolic risk reduction.
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http://dx.doi.org/10.1155/2016/9717948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745913PMC
February 2016

Diagnosis, therapeutic response assessment, and detection of disease recurrence in cardiac sarcoidosis: Integral role of cardiac PET.

J Nucl Cardiol 2016 Aug 25;23(4):850-3. Epub 2016 Jan 25.

Heart and Vascular Institute, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.

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http://dx.doi.org/10.1007/s12350-016-0399-1DOI Listing
August 2016

Left main coronary artery disease: A review of the spectrum of noninvasive diagnostic modalities.

J Nucl Cardiol 2016 12 20;23(6):1411-1429. Epub 2015 Oct 20.

Heart and Vascular Institute, Henry Ford Hospital, 2799 West Grand Blvd, K-14, Detroit, MI, 48202, USA.

Medically managed significant left main (LM) stem disease has been considered a determinant of increased cardiac mortality approaching 50% at 3-year follow-up. Despite the clinical significance of LM disease, studies comparing the various diagnostic modalities, especially noninvasive, are sparse. Clinicians, particularly imagers, should be aware of the strengths and weaknesses of existing modalities to diagnose LM disease as integrating many clues (history, symptoms, electrocardiogram, and stress hemodynamics are essential to suspect this diagnosis and proceed to the next step). Here we review the existing data on the current role of electrocardiography, nuclear myocardial perfusion imaging (single photon emission computed tomography and positron emission tomography), stress echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging in diagnostic evaluation of LM disease. Wherever applicable we have extended our discussion to multivessel coronary artery disease encompassing scenarios where LMS can present as LM equivalent with or without extensive multivessel coronary artery disease.
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http://dx.doi.org/10.1007/s12350-015-0152-1DOI Listing
December 2016

Strain Imaging: From Physiology to Practical Applications in Daily Practice.

Cardiol Rev 2016 Mar-Apr;24(2):56-69

From the *Department of Cardiology, St Joseph Mercy Oakland Hospital, Pontiac, MI; and †Department of Internal Medicine, Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI.

Non-Doppler, 2-dimensional strain imaging is a new echocardiographic technique for obtaining strain and strain rate measurements, which serves as a major advancement in understanding myocardial deformation. It analyzes motion in ultrasound imaging by tracking speckles in 2 dimensions. There are a lot of data emerging with multiple applications of strain imaging in the clinical practice of echocardiography. As incorporation of strain imaging in daily practice has been challenging, we intend to systematically highlight the top 10 applications of speckle-tracking echocardiography, which every cardiologist should be aware of: chemotherapy cardiotoxicity, left ventricular assessment, cardiac amyloidosis, hypertrophic obstructive cardiomyopathy, right ventricular dysfunction, valvular heart diseases (aortic stenosis and mitral regurgitation), cardiac sarcoidosis, athlete heart, left atrial assessment, and cardiac dyssynchrony.
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http://dx.doi.org/10.1097/CRD.0000000000000067DOI Listing
November 2016

Fragmented QRS on surface electrocardiogram is not a reliable predictor of myocardial scar, angiographic coronary disease or long term adverse outcomes.

Cardiovasc Diagn Ther 2014 Aug;4(4):279-86

1 Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI, USA ; 2 Cardiovascular Physicians of North Atlanta, Roswell, Georgia.

Purpose: Conflicting evidence remains regarding the value of fragmented QRS (fQRS) on surface electrocardiogram (EKG). We present the 5-year outcome of patients with fQRS on EKG and its correlation to SPECT and coronary angiography (CA).

Methods: We retrospectively studied EKG's in 248 consecutive patients undergoing SPECT and CA with known or suspected coronary artery disease (CAD). The presence of fQRS or Q waves in two contiguous EKG leads was correlated with major coronary artery distributions on SPECT and cath. Patients with bundle-branch block, paced-rhythm or absence of EKG within one month of SPECT were excluded. The final EKG data for 238 patients were analyzed and compared with myocardial scar on SPECT and the presence of significant (>50%) coronary stenosis on CA. Predictors of MACE (death, MI, heart failure) were evaluated. Freedom from all-cause mortality was assessed by Kaplan-Meier analysis.

Results: Of 238 patients, no significant difference was noted in the presence of scar on SPECT in fQRS (3/77; 3.8%) versus no fQRS (11/161; 6.8%) (P=0.56); or CA based CAD (55/77; 71% fQRS) and no fQRS (99/161, 61.4%) (P=0.20). EKG Q wave presence was similar in both groups: (12/77; 15.5% fQRS), (17/161; 10.5% no fQRS) (P=0.3). Patients with CA based significant LAD disease were 3.680 times more likely to have fQRS (P=0.04), however, fQRS was not significantly associated with MACE (P=0.92) or all-cause mortality (P=0.93).

Conclusions: This study does not support routine assessment of fQRS on surface EKG as a reliable predictor of SPECT myocardial scar, MACE or all-cause mortality over a long period of follow-up.
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http://dx.doi.org/10.3978/j.issn.2223-3652.2014.08.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147086PMC
August 2014

Prognostic value of regadenoson myocardial single-photon emission computed tomography in patients with different degrees of renal dysfunction.

Eur Heart J Cardiovasc Imaging 2014 Aug 3;15(8):933-40. Epub 2014 Apr 3.

Department of Internal Medicine, Heart and Vascular Institute, Henry Ford Hospital, 2799 West Grand Blvd, K-14, Detroit, MI 48202, USA

Aims: Patients with chronic kidney disease (CKD) have worse cardiovascular outcomes. The prognostic value of the new pharmacological stressor regadenoson (REG) in patients with varying levels of kidney function is not known (REG-SPECT). Furthermore, the impact of varying levels of kidney dysfunction on cardiac outcomes in patients undergoing REG-SPECT has not been defined. Our objective was to evaluate the prognostic value of regadenoson stress imaging in patients with different levels of kidney dysfunction.

Methods And Results: We followed 1107 consecutive patients who underwent REG-SPECT for a mean duration of 1.8 ± 0.8 years. CKD was defined as estimated glomerular filtration rate (GFR) 60 mL/min/1.73 m(2). Kaplan-Meier survival analysis was performed to evaluate survival, free of major adverse cardiac events (MACE). CKD patients with GFR <60 (47% male, mean age 70 years) had a higher prevalence of cardiac risk factors and a history of coronary artery disease and were on significantly more cardiac medications (P < 0.001) than those with GFR >60. Patients with GFR <60 were significantly more likely to develop adverse cardiac outcomes including congestive heart failure (CHF) (P = 0.02), cardiac death (P < 0.001), all-cause death (P < 0.001), and MACE (P < 0.001) over the period of follow-up. Cardiac death increased with worsening levels of perfusion defects (SSS) across the entire spectrum of renal function (P < 0.001). GFR <60 was an independent predictor of MACE with a hazard ratio (HR) of 1.49 (95% CI: 1.06-2.08). The presence of transient ischaemic dilation (TID) was associated with an HR of 5.06 (95% CI: 1.43-17.90).

Conclusions: Renal function is a powerful risk predictor in patients undergoing REG-SPECT. REG-SPECT provides robust prognostication across the entire spectrum of renal function.
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http://dx.doi.org/10.1093/ehjci/jeu036DOI Listing
August 2014

Feasibility, safety and accuracy of regadenoson-atropine (REGAT) stress echocardiography for the diagnosis of coronary artery disease: an angiographic correlative study.

Int J Cardiovasc Imaging 2014 Mar 25;30(3):515-22. Epub 2014 Jan 25.

Seton Heart Institute, Seton Medical Center, Kyle, TX, 78640, USA.

Regadenoson (REG), a selective A2A receptor vasodilator, has not been widely evaluated in stress echocardiography (SE). We report results of 45 patients participating in REG + atropine (REGAT) SE protocol conducted in a single-center prospective trial. The REGAT study enrolled subjects before a clinically indicated cardiac catheterization for suspected coronary artery disease (CAD). After rest imaging, a 2 mg Atropine (AT) bolus followed by 400 mcg of REG was given. Standard stress imaging views were obtained and interpreted in blinded fashion. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated using cardiac catheterization >70 % stenosis as gold standard. Additional endpoints included major adverse cardiac events (MACE) and patient questionnaire responses. The mean duration of REGAT was 18 ± 7.2 min. There were no MACE, with only transient side-effects of dry mouth, shortness of breath, and headache. The incidence of significant CAD was 51.1 %. The sensitivity and specificity for significant stenosis was 60.9 and 86.4 %, with a PPV and NPV of 82.4 and 67.9 %. By coronary territories, the sensitivity, specificity, PPV, and NPV were: left anterior descending artery 58.8, 92.9, 83.3, and 78.8 %; left circumflex artery 6.7, 93.3, 33.3, and 67.7 %; and right coronary artery 16.7, 93.9, 50, and 75.6 %. Over 90 % of subjects reported feeling comfortable, with 83 % preferring REGAT as a future stress modality. The REGAT protocol is fast, safe, and well-tolerated with good specificity for CAD detection, but its low sensitivity and NPV precludes it from being an imaging modality for routine use.
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http://dx.doi.org/10.1007/s10554-014-0363-6DOI Listing
March 2014

Comparison of hemodynamic and stress testing variables in patients undergoing regadenoson stress myocardial perfusion imaging to regadenoson with adjunctive low-level exercise myocardial perfusion imaging.

J Nucl Cardiol 2013 Jun 21;20(3):336-43; quiz 344-5. Epub 2013 Feb 21.

Department of Internal Medicine, Heart and Vascular Institute, Henry Ford Hospital, K-14, Detroit, MI 48202, USA.

Background: Regadenoson (REG), a selective adenosine A2a receptor agonist, is becoming the preferred pharmacologic agent for stress myocardial perfusion imaging (MPI). Hemodynamic and stress variables, immediate safety and use of aminophylline when using REG combined with low-level exercise (REG WALK MPI) compared with REG MPI, have not been well studied and formed the basis of our study.

Methods: Retrospective evaluation of patients who underwent REG MPI (n = 887) was compared to patients undergoing REG WALK MPI (n = 485) from January to November 2009. Patient demographics, hemodynamic parameters, REG MPI data, side effects, immediate major clinical events, and use of aminophylline were evaluated.

Results: Patients in REG WALK MPI group tended to be younger, male and obese compared to patients in REG MPI group. REG WALK MPI patients had higher stress heart rate (103 ± 20.5 vs 84 ± 19 bpm, P = .001), higher heart rate reserve (36.3 ± 19 vs 14.7 ± 15.5 bpm, P < .001), and greater systolic blood pressure rise (4.8 ± 21.3 vs -8.9 ± 19.8 mm Hg, P < .001), compared to REG MPI patients. No major adverse events were reported immediately after REG WALK MPI. There were no differences in drug-related side effects in between the two groups; however, the use of aminophylline was lower in REG WALK MPI Group (5.6% vs 11.4%, P = .001).

Conclusion: REG WALK MPI gives more favorable hemodynamic response with lesser use of aminophylline and no increase in adverse events when compared with REG MPI.
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http://dx.doi.org/10.1007/s12350-012-9671-1DOI Listing
June 2013

The role of noninvasive imaging in coronary artery disease detection, prognosis, and clinical decision making.

Can J Cardiol 2013 Mar 26;29(3):285-96. Epub 2013 Jan 26.

University of Ottawa Heart Institute, Department of Medicine (Cardiology), Ottawa, Ontario, Canada.

A vast array of noninvasive imaging modalities is available for the evaluation of the presence and severity of coronary artery disease (CAD). Choosing the right test can be challenging but is critical for proper patient diagnosis and management. Presently available imaging tests for CAD include: (1) nuclear myocardial perfusion imaging procedures (single-photon emission tomography) and positron emission tomography, (2) stress echocardiography, (3) computed tomography coronary angiography, and (4) cardiac magnetic resonance imaging. Exercise treadmill testing electrocardiography is another alternative that we will discuss briefly. Selection of the most appropriate imaging modality requires knowledge of the clinical question being addressed, patient characteristics (pretest probability and prevalence of disease), the strengths, limitations, risks, costs, and availability of each procedure. To assist with test selection, we review the relevant literature in detail to consider the relative merits of cardiac imaging modalities for: (1) detection of CAD, (2) risk stratification and prognostication, and (3) guiding clinical decision making.
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http://dx.doi.org/10.1016/j.cjca.2012.10.022DOI Listing
March 2013

Coronary CT angiography after stress testing: an efficient use of resources? Implications of the Advanced Cardiovascular Imaging Consortium (ACIC) results.

J Nucl Cardiol 2012 Aug;19(4):649-57

Coronary CT angiography (CCTA) has matured to be a fast noninvasive imaging test in the evaluation of coronary artery disease (CAD). It has demonstrated excellent accuracy for defining the presence and the severity of luminal coronary artery stenoses and is probably the best noninvasive test to reliably exclude atherosclerotic coronary disease. Furthermore, accumulating CCTA data indicate that it can identify individuals at risk for all-cause mortality. It is also well known that despite the wealth of data regarding diagnostic and prognostic values of stress testing in CAD, up to 10% of stress imaging studies are considered inconclusive, leading to subsequent invasive coronary angiography for definitive diagnosis often with negative results. Moreover, recent data indicate that up to 30 % of patients undergoing angiography have no significant CAD despite a majority of them having had a prior stress test. Whether CCTA can serve as a cost-effective methodology to invasive angiography has been a source of active research. In this context, we will discuss the implications of the recently published data from the Advanced Cardiovascular Imaging Consortium registry looking at the use of CCTA after stress testing in Michigan.
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http://dx.doi.org/10.1007/s12350-012-9578-xDOI Listing
August 2012

Significance of high sensitivity C-reactive protein and D-dimer in evaluating intracardiac thrombus and spontaneous echo contrast in patients referred for transesophageal echocardiography: a prospective study.

Cardiol J 2012 ;19(3):267-73

Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan 48202, USA.

Background: Intra-cardiac thrombus (ICT) and spontaneous echo contrast (SEC) are considered hypercoagulable and inflammatory conditions. We aimed to determine if high sensitivity C-reactive protein (CRP) and D-dimer (DD), in combination with variables of lower thrombotic risk (normal ejection fraction [NEF], sinus rhythm [NSR]), may predict the absence of ICT/SEC.

Methods And Results: Consecutive patients referred for transesophageal echocardiogram (TEE) for evaluation of cardioembolic source were prospectively enrolled. CRP and DD levels were determined at the time of TEE. 124 patients were enrolled, of whom 21 had ICT/SEC. The combination of NSR/NEF had a negative predictive value (NPV) of 98.6% for absence of ICT/SEC. The NPVs of CRP and DD were 93.6% and 85%, respectively. Adding either CRP or DD to NSR/NEF combination increased the NPV to 100%. Log CRP was significantly associated with ICT/SEC.

Conclusions: The presence of NSR and NEF may defer the need for TEE for ICT/SEC evaluation. CRP association with ICT/SEC suggests that inflammation plays a role in ICT/SEC formation. Whether CRP and DD should become routine in the triage process of TEE for ICT/SEC evaluation requires further large scale prospective studies.
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http://dx.doi.org/10.5603/cj.2012.0048DOI Listing
October 2012

Rationale, design, and goals of the Advanced Cardiovascular Imaging Consortium (ACIC): A Blue Cross Blue Shield of Michigan collaborative quality improvement project.

Am Heart J 2012 Mar;163(3):346-53

William Beaumont Hospital, Royal Oak, MI 48073, USA.

Background: Coronary computed tomography angiography (CCTA) is an emerging noninvasive anatomical method for evaluation of patients with suspected coronary artery disease (CAD). Multicenter clinical registries are key to efforts to establish the role of CCTA in CAD diagnosis and management. The Advanced Cardiovascular Imaging Consortium (ACIC) is a statewide, multicenter collaborative quality initiative with the intent to establish quality and appropriate use of CCTA in Michigan.

Methods: The ACIC is sponsored by the Blue Cross Blue Shield of Michigan/Blue Care Network, and its 47 sites include imaging centers that offer CCTA and meet established structure and process standards for participation. Patients enrolled include those with suspected ischemia with or without known CAD, and individuals across the entire spectrum of CAD risk. Patient demographics, history, CCTA scan-related data and findings, and 90-day follow-up data are entered prospectively into a centralized database with strict validation tools and processes. Collaborative quality initiatives include radiation dose reduction and appropriate CCTA use by education and feedback to participating sites and referring physicians.

Conclusions: Across a wide range of institutions, the ACIC permits evaluation of "real-world" utilization and effectiveness of CCTA and examines an alternative, nontraditional approach to utilization management wherein physicians and payers collaborate to address the growing problem of cardiac imaging overutilization.
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http://dx.doi.org/10.1016/j.ahj.2011.11.018DOI Listing
March 2012
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