silent MI coronary revascularization prevention guideline computed tomography, CT myocardial perfusion scintigraphy, MPS risk stratification

Size: px
Start display at page:

Download "silent MI coronary revascularization prevention guideline computed tomography, CT myocardial perfusion scintigraphy, MPS risk stratification"

Transcription

1 1-2 prevention guideline 3 4 risk stratification intermediate risk Rose' paradox biomarker silent MI coronary revascularization computed tomography, CT myocardial perfusion scintigraphy, MPS CT MPS European Heart Journal 2010 July 14 Working Group on Nuclear Cardiology and Cardiac CT of the European Society of Cardiology CT MPS hard cardiac events 3

2 non-hemodynamically significant plaques hemodynamically significant stenosis CT MPS CT / microcirculation 5 MPS revascularization 1-2 CT medial calcification, non-atherosclerotic vascular biological age coronary artery calcium, CAC CAC CT Agatston Score calcium coverage score cross-sectional Agatston Score Agatston Score Agatston Score 6 CAC Multi-Ethnic Study of Atherosclerosis MESA CAC calcium percentiles Coronary artery calcium

3 CAC percentile CAC Prognostic value of coronary artery calcium in asymptomatic subjects CAC 3-5 <1% Agatston Score> MESA CAC 70% 52% CAC Agatston Score> Framingham risk score CAC Agatston score >300 Coronary calcium in type 2 diabetic patients silent ischemia CAC silent ischemia revascularization silent ischemia CAC Coronary calcium in the elderly and in renal disease CAC CAC CAC 5

4 CAC Measurement of coronary artery calcium progression CAC CAC 15~25% CAC statin CAC meta-analysis CAC 9 Coronary computed tomography angiography positive remodeling CT 10 retrospective ~ % coronary atherosclerosis 5% revascularization 26~36% 12 primary prevention risk stratification

5 Myocardial perfusion scintigraphy, MPS MPS MPS in asymptomatic subjects MPS 2~3 <1% MPS silent myocardial ischemia silent ischemia 50~60 2% 90 15% 7.5% intermediate risk stress MPS 4% 1.6% 13 MPS MPS in asymptomatic type 2 diabetic patients meta-analysis MPS 0.85% MPS 5.9% MPS MPS DIAD 15 Detection of Silent Myocardial Ischemia in Asymptomatic Diabetics MPS MPS MPS 21% MPS autonomic cardiac neuropathy 4.8 MPS 2.4% MPS 0.4% MPS 6% 33/561 MPS 1% MPS MPS Combination of coronary calcium or coronary computed tomography angiography with myocardial perfusion scintigraphy 7

6 MPS 400 Agatston Scores MPS MPS MPS 18% Agatston Score % Agatston Score % Agatston Score Agatston Score 100 MPS MPS Agatston Score 100 Risk assessment in subjects with familial hypercholesterolemia and with familial history of premature coronary artery disease FH 24% MPS 26% % 64% 78% P< MPS 18 MPS MPS 4.7 MPS 14.5 MPS Agatston score> % MPS Agatston score 0~10 21% MPS negative predictive power MPS level of evidence C

7 CAC intermediate-risk Recommendation IIa MPS recommendation III MPS revascularization recommendation IIa premature CAD MPS recommendation IIb coronary CT angiography recommendation III CAC recommendation III Reference 01. Muller-Nordhorn J, Binting S, Roll S, Willich SN. An update on regional variation in cardiovascular mortality within Europe. Eur Heart J 2008;29: Yach D, Hawkes C, Gould CL, Hofman KJ. The global burden of chronic diseases: overcoming impediments to prevention and control. JAMA 2004;291: Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur Heart J 2007; 28: Unal B, Critchley JA, Capewell S. Modelling the decline in coronary heart disease deaths in England and Wales, : comparing contributions from primary prevention and secondary prevention. BMJ 2005;331: Schuijf JD, Wijns W, Jukema JW, et al. Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol 2006;48: Greenland P, Bonow RO, Brundage BH, et al. ACCF/ AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 2007;49: Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008;358: Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 2004;291: McCullough PA, Chinnaiyan KM. Annual progression of coronary calcification in trials of preventive therapies: a systematic review. Arch Intern Med 2009; 169: Motoyama S, Sarai M, Harigaya H, et al. Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute 9

8 coronary syndrome. J Am Coll Cardiol 2009;54: Choi EK, Choi SI, Rivera JJ, et al. Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals. J Am Coll Cardiol 2008;52: Romeo F, Leo R, Clementi F, et al. Multislice computed tomography in an asymptomatic high-risk population. Am J Cardiol 2007;99: Khandaker MH, Miller TD, Chareonthaitawee P, Askew JW, Hodge DO, Gibbons RJ. Stress single photon emission computed tomography for detection of coronary artery disease and risk stratification of asymptomatic patients at moderate risk. J Nucl Cardiol 2009;16: Shaw LJ, Iskandrian AE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol 2004; 11: Young LH, Wackers FJ, Chyun DA, et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. JAMA 2009;301: Anand DV, Lim E, Hopkins D, et al. Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy. Eur Heart J 2006;27: Nasir K, Michos ED, Rumberger JA, et al. Coronary artery calcification and family history of premature coronary heart disease: sibling history is more strongly associated than parental history. Circulation 2004; 110: Blumenthal RS, Becker DM, Moy TF, Coresh J, Wilder LB, Becker LC. Exercise thallium tomography predicts future clinically manifest coronary heart disease in a high-risk asymptomatic population. Circulation 1996;93: Blumenthal RS, Becker DM, Yanek LR, et al. Comparison of coronary calcium and stress myocardial perfusion imaging in apparently healthy siblings of individuals with premature coronary artery disease. Am J Cardiol 2006;97:

Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg

Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg 2 nd Annual Duke Renal Transplant Symposium March 1, 2014 Durham, NC Joseph G. Rogers, M.D. Associate

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Computed Tomography to Detect Coronary Artery Calcification File Name: computed_tomography_to_detect_coronary_artery_calcification Origination: 3/1994 Last CAP Review 11/2014 Next

More information

Computed tomography coronary angiography in patients with suspected coronary artery disease

Computed tomography coronary angiography in patients with suspected coronary artery disease Computed tomography coronary angiography in patients with suspected coronary artery disease Prof. Dr. Stephen Schröder, EC, FESC Department of Cardiology Klinik am Eichert Göppingen Germany -No conflicts

More information

Background. Stages. we detect these easily? New technology: The CT scanner, 1971. Example: calcium in peripheral vascular disease.

Background. Stages. we detect these easily? New technology: The CT scanner, 1971. Example: calcium in peripheral vascular disease. Coronary Calcium Background Ahtherosclerosis: Maturation of a plaque into symptomatic disease Coronary Artery disease Fatty Streak: Autopsy, seen in autopsy Occurs very early, 0s, late teens Seen almost

More information

Will The Coronary Calcium Score Affect the Decision To Treat With Statins?

Will The Coronary Calcium Score Affect the Decision To Treat With Statins? Will The Coronary Calcium Score Affect the Decision To Treat With Statins? Amresh Raina M.D. Division of Cardiology University of Pennsylvania Disclosures No financial relationships relevant to this presentation

More information

Efficient Evaluation of Chest Pain

Efficient Evaluation of Chest Pain Efficient Evaluation of Chest Pain Vikranth Gongidi, DO FACC FACOI Indian River Medical Center Vero Beach, FL No Disclosures Outline Background Chest pain pathway Indications for stress test Stress test

More information

Noninvasive testing can provide useful information for

Noninvasive testing can provide useful information for CONTINUING EDUCATION Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Noninvasive Risk Stratification and a Conceptual Framework for the Selection of Noninvasive

More information

Imaging for Improving Therapy

Imaging for Improving Therapy JACC: CARDIOVASCULAR IMAGING VOL. 6, NO. 5, 2013 2013 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-878X/$36.00 PUBLISHED BY ELSEVIER INC. http://dx.doi.org/10.1016/j.jcmg.2013.04.002 EDITORIAL

More information

Objectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History

Objectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History Preoperative Cardiac Risk Stratification for Noncardiac Surgery Kimberly Boddicker, MD FACC Essentia Health Heart and Vascular Center 27 th Heart and Vascular Conference May 13, 2011 Objectives Summarize

More information

Perioperative Cardiac Evaluation

Perioperative Cardiac Evaluation Perioperative Cardiac Evaluation Caroline McKillop Advisor: Dr. Tam Psenka 10-3-2007 Importance of Cardiac Guidelines -Used multiple times every day -Patient Safety -Part of Surgical Care Improvement Project

More information

Nuclear Stress Testing and Multi- Modality Imaging

Nuclear Stress Testing and Multi- Modality Imaging Nuclear Stress Testing and Multi- Modality Imaging Dr. Steven Mottl Dallas, Tx No Financial Discloures Learning Objectives Order the Right Test for the Right Patient How to risk stratify patients Review

More information

Main Effect of Screening for Coronary Artery Disease Using CT

Main Effect of Screening for Coronary Artery Disease Using CT Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,

More information

Coronary Calcium Scoring: the Logical Way to Assess CVS Risk?

Coronary Calcium Scoring: the Logical Way to Assess CVS Risk? Coronary Calcium Scoring: the Logical Way to Assess CVS Risk? Dr Chris Ellis Cardiologist Greenlane CVS Service Auckland City Hospital & Auckland Heart Group AHG Winter Symposium. 24 July 2010 (Is) Coronary

More information

Statins: Can there be too much of a good thing?

Statins: Can there be too much of a good thing? Statins: Can there be too much of a good thing? Spoiler alert No Oh Contraire Haaaaiiiiiiile No! Frequently under prescribing statin therapy! Typical Case 68 YO Smoker ACS Multiple prior PCI s Multiple

More information

Listen to your heart: Good Cardiovascular Health for Life

Listen to your heart: Good Cardiovascular Health for Life Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular

More information

Q1: Global risk assessment using PROCAM, SCORE, FRAMINGHAM or REYNOLDS ecc is sufficient YES NO NEED MORE DATA DISCUSS within Taskforce Your Comments

Q1: Global risk assessment using PROCAM, SCORE, FRAMINGHAM or REYNOLDS ecc is sufficient YES NO NEED MORE DATA DISCUSS within Taskforce Your Comments Site ID: Q1: Global risk assessment using PROCAM, SCORE, FRAMINGHAM or REYLDS ecc is sufficient Q2: The value of an emerging test is best assessed using C - statistics Q3: Atherosclerosis imaging may be

More information

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with

More information

September 2003 Myocardial Perfusion Imaging: a game of acronyms. Mehret Mandefro, Harvard Medical School IV. Gillian Lieberman, MD

September 2003 Myocardial Perfusion Imaging: a game of acronyms. Mehret Mandefro, Harvard Medical School IV. Gillian Lieberman, MD September 2003 Myocardial Perfusion Imaging: a game of acronyms MIBI, Thal, ETT & SPECT Mehret Mandefro, Harvard Medical School IV Objectives Review indications for when myocardial perfusion scans should

More information

CARDIAC. Spiral CT Scan for Detecting Coronary Artery Stenosis. Introduction

CARDIAC. Spiral CT Scan for Detecting Coronary Artery Stenosis. Introduction CARDIAC A. Soltani Shirazi MD 1. N. Nasehi MD 2. M. Sametzadah MD 1. H. Saberi MD 3. M.A. Shabani MD 3. Spiral CT Scan for Detecting Coronary Artery Stenosis Background/ Objective: Coronary vessel calcification

More information

Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults. Learn and Live SM. ACCF/AHA Pocket Guideline

Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults. Learn and Live SM. ACCF/AHA Pocket Guideline Learn and Live SM ACCF/AHA Pocket Guideline Based on the 2010 ACCF/AHA Guideline Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults November 2010 Guideline for Assessment of Cardiovascular

More information

Myocardial Perfusion Imaging Versus CT Coronary Angiography: When to Use Which?

Myocardial Perfusion Imaging Versus CT Coronary Angiography: When to Use Which? CONTINUING EDUCATION Myocardial Perfusion Imaging Versus CT Coronary Angiography: When to Use Which? Balaji Tamarappoo and Rory Hachamovitch Section of Cardiovascular Imaging, Department of Cardiovascular

More information

MYOCARDIAL PERFUSION COMPUTED TOMOGRAPHY PhD course in Medical Imaging. Anne Günther Department of Radiology OUS Rikshospitalet

MYOCARDIAL PERFUSION COMPUTED TOMOGRAPHY PhD course in Medical Imaging. Anne Günther Department of Radiology OUS Rikshospitalet MYOCARDIAL PERFUSION COMPUTED TOMOGRAPHY PhD course in Medical Imaging Anne Günther Department of Radiology OUS Rikshospitalet CORONARY CT ANGIOGRAPHY (CTA) Accurate method in the assessment of possible

More information

Current Challenges in Management of Aortic Stenosis?

Current Challenges in Management of Aortic Stenosis? Current Challenges in Management of Aortic Stenosis? Robert O. Bonow, MD, MS Northwestern University Feinberg School of Medicine Bluhm Cardiovascular Institute Northwestern Memorial Hospital No Relationships

More information

Non-invasive functional testing in 2014

Non-invasive functional testing in 2014 Non-invasive functional testing in 2014 Bjarne Nørgaard Department Cardiology B Aarhus University Hospital Skejby, Disclosures: Research grants: Edwards and Siemens Non-invasive functional testing in 2014

More information

6/5/2014. Objectives. Acute Coronary Syndromes. Epidemiology. Epidemiology. Epidemiology and Health Care Impact Pathophysiology

6/5/2014. Objectives. Acute Coronary Syndromes. Epidemiology. Epidemiology. Epidemiology and Health Care Impact Pathophysiology Objectives Acute Coronary Syndromes Epidemiology and Health Care Impact Pathophysiology Unstable Angina NSTEMI STEMI Clinical Clues Pre-hospital Spokane County EMS Epidemiology About 600,000 people die

More information

The worldwide burden of peripheral artery disease

The worldwide burden of peripheral artery disease www.tasc-2-pad.org The worldwide burden of peripheral artery disease The role of the physician Based on the Inter-Society Consensus Edited by Dr Kenneth Harris The University of Western Ontario, London,

More information

ASCVD Risk Calculators, Controversies and Women

ASCVD Risk Calculators, Controversies and Women ASCVD Risk Calculators, Controversies and Women Ann Cannon, RN, BSN Clinical Specialist for Cardiovascular Health and Heart Failure, MaineHealth Nurse Care Manager, Turning Point Heart Health Program Maine

More information

Cardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease

Cardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease Cardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease What is Cardiac Rehabilitation? Cardiac rehabilitation is a comprehensive exercise, education, and behavior modification

More information

Clinical research Imaging

Clinical research Imaging European Heart Journal (2006) 27, 713 721 doi:10.1093/eurheartj/ehi808 Clinical research Imaging Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary

More information

The Canadian Association of Cardiac

The Canadian Association of Cardiac Reinventing Cardiac Rehabilitation Outside of acute care institutions, cardiovascular disease is a chronic, inflammatory process; the reduction or elimination of recurrent acute coronary syndromes is a

More information

FFR CT : Clinical studies

FFR CT : Clinical studies FFR CT : Clinical studies Bjarne Nørgaard Department Cardiology B Aarhus University Hospital Skejby, Denmark Disclosures: Research grants: Edwards and Siemens Coronary CTA: High diagnostic sensitivity

More information

Postoperative Myocardial Infarction: Diagnosis and Management

Postoperative Myocardial Infarction: Diagnosis and Management Postoperative Myocardial Infarction: Diagnosis and Management Todd M. Brown, MD, MSPH Chief Fellow Division of Cardiovascular Diseases December 9, 2008 CHEST PAIN NON-ANGINAL UNSURE ANGINAL STABLE ANGINA

More information

and successfully conclude the act of sexual intercourse to the satisfaction of themale-

and successfully conclude the act of sexual intercourse to the satisfaction of themale- Is Erectile Dysfunction the New Penile Angina? Nick Gerning General Cardiologist Interventional Cardiologist the ability to initiate, sustain and successfully conclude the act of sexual intercourse to

More information

ECG may be indicated for patients with cardiovascular risk factors

ECG may be indicated for patients with cardiovascular risk factors eappendix A. Summary for Preoperative ECG American College of Cardiology/ American Heart Association, 2007 A1 2002 A2 European Society of Cardiology and European Society of Anaesthesiology, 2009 A3 Improvement,

More information

Cardiovascular risk calculator for diabetic patients 이해영서울대학병원순환기내과

Cardiovascular risk calculator for diabetic patients 이해영서울대학병원순환기내과 Cardiovascular risk calculator for diabetic patients 이해영서울대학병원순환기내과 Contents Need of risk engine for diabetic patients Three main approaches of global cardiovascular risk estimation in diabetes Validation

More information

The Use of Nuclear Cardiology in Clinical Decision Making. T. Bryson Struse, D.O., F.A.C.O.I., D.A.B.N.M. Carondelet Heart and Vascular Institute

The Use of Nuclear Cardiology in Clinical Decision Making. T. Bryson Struse, D.O., F.A.C.O.I., D.A.B.N.M. Carondelet Heart and Vascular Institute The Use of Nuclear Cardiology in Clinical Decision Making T. Bryson Struse, D.O., F.A.C.O.I., D.A.B.N.M. Carondelet Heart and Vascular Institute Cardiovascular disease remains the leading cause of death

More information

Additional Tests for Modification of Cardiovascular Risk

Additional Tests for Modification of Cardiovascular Risk MOH CPG: Screening for Cardiovascular Disease and Risk Factors Additional Tests for Modification of Cardiovascular Risk Terrance Chua FACC, FESC Additional Tests for Modification of Cardiovascular Risk

More information

percutaneous coronary intervention PCI PCI 1 PCI coronary rotational atherectomy 1 CT coronary computed tomographic angiography CCTA Agatston 100

percutaneous coronary intervention PCI PCI 1 PCI coronary rotational atherectomy 1 CT coronary computed tomographic angiography CCTA Agatston 100 20142222 Chin J Intervent Cardiol, 2014, Vol 22, No.2 69 R541.4 percutaneous coronary interventionpci coronary rotational atherectomy 40 49 50% 60 69 80 DOI10. 3969/j. issn. 1004-8812. 2014. 02. 001 [1-2]

More information

64-Slice Cardiovascular CT Angiography: A Clinical Accuracy Evaluation

64-Slice Cardiovascular CT Angiography: A Clinical Accuracy Evaluation 64-Slice Cardiovascular CT Angiography: A Clinical Accuracy Evaluation Jeffrey J Fine, PhD, MS, Christie B Hopkins, MD, FACC, Nicol Ruff, MA, F Carter Newton, MD, FACC. Department of Investigator Initiated

More information

The Effect of Rapid Acquisition Myocardial Perfusion Imaging on Improving the Diagnosis of Coronary Artery Disease

The Effect of Rapid Acquisition Myocardial Perfusion Imaging on Improving the Diagnosis of Coronary Artery Disease The Effect of Rapid Acquisition Myocardial Perfusion Imaging on Improving the Diagnosis of Coronary Artery Disease Alicia Mecklai, MD IRB Proposal ICCR, July 21, 2008 A. Study Purpose and Rationale The

More information

Appropriateness in cardiology

Appropriateness in cardiology Bruxelles, September 3rd, 2009 Appropriateness in cardiology Eugenio Picano Istituto di Fisiologia Clinica, CNR, Pisa US Health Care Plan 1964 Don t ever argue with me. I ll go a hundred Million or a billion

More information

Is There a Role for Nuclear Cardiology in the Era of Cardiac CT? E. Gordon DePuey, M.D. Select the Appropriate Test to Meet the Patient Need

Is There a Role for Nuclear Cardiology in the Era of Cardiac CT? E. Gordon DePuey, M.D. Select the Appropriate Test to Meet the Patient Need Is There a Role for Nuclear Cardiology in the Era of Cardiac CT? E. Gordon DePuey, M.D. Clinical Professor of Radiology Icahn School of Medicine at Mt. Sinai Director of Nuclear Medicine Mt. Sinai St.

More information

Coronary artery disease (CAD) remains the

Coronary artery disease (CAD) remains the Role of Cardiac CT in Atherosclerosis Imaging and Risk Stratification Firoz Gani, MBBS, MRCP, Cardiology Research Registrar, Cardiac Imaging & Research Centre, Wellington Hospital (South), London, UK.

More information

Worldwide, 200 million individuals

Worldwide, 200 million individuals Reviews/Commentaries/ADA R E V I E W A R T I C L E Statements Cardiac Imaging for Risk Stratification in Diabetes JEROEN J. BAX, MD 1 SILVIO E. INZUCCHI, MD 2 ROBERT O. BONOW, MD 3 JOANNE D. SCHUIJF, MSC

More information

Exercise Stress Electrocardiography. Historical Perspective. Historical Perspective. Subject Population. Learning Objectives. ECG Exercise Testing

Exercise Stress Electrocardiography. Historical Perspective. Historical Perspective. Subject Population. Learning Objectives. ECG Exercise Testing Learning Objectives Exercise Stress Electrocardiography Gerald F. Fletcher MD Mayo Clinic Florida No Disclosures Provide an understanding of the value of the multiple ECG and Physiological measures that

More information

Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care

Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY

More information

Cardiac Imaging for Risk Stratification in Asymptomatic Diabetes

Cardiac Imaging for Risk Stratification in Asymptomatic Diabetes Cardiac Imaging for Risk Stratification in Asymptomatic Diabetes Arthur J.H.A. Scholte The research described in this thesis was performed at the department of Cardiology of the Leiden University Medical

More information

RISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department

RISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department RISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department Sohil Pothiawala FAMS (EM), MRCSEd (A&E), M.Med (EM), MBBS Consultant Dept. of Emergency Medicine Singapore General Hospital

More information

Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations.

Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. INTRODUCTION Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. Although decrease in cardiovascular mortality still major cause of morbidity & burden of disease.

More information

National Imaging Associates, Inc. Clinical guidelines

National Imaging Associates, Inc. Clinical guidelines National Imaging Associates, Inc. Clinical guidelines Original Date: February 2010 STRESS ECHOCARDIOLOGY Page 1 of 15 CPT Codes: 93350, 93351, + 93352 Last Reviewed Date: June 2012 Guideline Number: NIA_CG_026

More information

Vascular Inflammation: A New Horizon in Cardiovascular Risk Assessment

Vascular Inflammation: A New Horizon in Cardiovascular Risk Assessment Vascular Inflammation: A New Horizon in Cardiovascular Risk Assessment 5 Vinayak Hegde and Ishmael Ching Akron General Medical Center, Ohio, USA 1. Introduction Coronary artery disease (CAD) remains the

More information

Optimizing Timing of ICD Implant Post MI

Optimizing Timing of ICD Implant Post MI Optimizing Timing of ICD Implant Post MI Cynthia M. Tracy, MD George Washington University Washington, DC No COI to declare % reduction Reduction in Total Mortality: ICD vs Control P=0.081 Boriani et al.

More information

Protocol. Cardiac Rehabilitation in the Outpatient Setting

Protocol. Cardiac Rehabilitation in the Outpatient Setting Protocol Cardiac Rehabilitation in the Outpatient Setting (80308) Medical Benefit Effective Date: 07/01/14 Next Review Date: 09/15 Preauthorization No Review Dates: 07/07, 07/08, 05/09, 05/10, 05/11, 05/12,

More information

For the NXT Investigators

For the NXT Investigators Diagnostic performance of non-invasive fractional flow reserve derived from coronary CT angiography in suspected coronary artery disease: The NXT trial Bjarne L. Nørgaard, Jonathon Leipsic, Sara Gaur,

More information

Investigation of Chest Pain in Men. Investigation of Chest Pain in Men 22/03/2016. One good reason to also focus on men

Investigation of Chest Pain in Men. Investigation of Chest Pain in Men 22/03/2016. One good reason to also focus on men Investigation of Chest Pain in Men Rural Health West Annual Conference Perth 20 th March, 2016 Ben King Investigation of Chest Pain in Men Rural Health West Annual Conference Perth 20 th March, 2016 Ben

More information

Evidence-Based ACC/AHA Guidelines for Cardiovascular Risk Assessment

Evidence-Based ACC/AHA Guidelines for Cardiovascular Risk Assessment Evidence-Based ACC/AHA Guidelines for Cardiovascular Risk Assessment Nathan D. Wong, PhD, FACC, FAHA Professor and Director Heart Disease Prevention Program Division of Cardiology, University of CA, Irvine

More information

Appropriate Use: Big Brother is Watching. Jason H. Rogers, MD Director, Interventional Cardiology UC Davis Medical Center

Appropriate Use: Big Brother is Watching. Jason H. Rogers, MD Director, Interventional Cardiology UC Davis Medical Center Appropriate Use: Big Brother is Watching Jason H. Rogers, MD Director, Interventional Cardiology UC Davis Medical Center Disclosures Consultant Boston Scientific, Medtronic, Middle Peak Medical, Millipede,

More information

2/20/2015. Cardiac Evaluation of Potential Solid Organ Transplant Recipients. Issues Specific to Transplantation. Kidney Transplantation.

2/20/2015. Cardiac Evaluation of Potential Solid Organ Transplant Recipients. Issues Specific to Transplantation. Kidney Transplantation. DISCLOSURES I have no relevant financial relationships to disclose. Cardiac Evaluation of Potential Solid Organ Transplant Recipients Michele Hamilton, MD Director, Heart Failure Program Cedars Sinai Heart

More information

List of Publications. Evaluation of stents and grafts. de Graaf FR, Schuijf JD. EuroIntervention 2010; 6 Suppl G: G48-56.

List of Publications. Evaluation of stents and grafts. de Graaf FR, Schuijf JD. EuroIntervention 2010; 6 Suppl G: G48-56. ist of Publications Diagnostic performance of 320-slice multidetector computed tomography coronary angiography in patients after coronary artery bypass grafting. de Graaf FR, van Velzen JE, Witkowska AJ,

More information

Osama Jarkas. in Chest Pain Patients. STUDENT NAME: Osama Jarkas DATE: August 10 th, 2015

Osama Jarkas. in Chest Pain Patients. STUDENT NAME: Osama Jarkas DATE: August 10 th, 2015 STUDENT NAME: Osama Jarkas DATE: August 10 th, 2015 PROJECT TITLE: Analysis of ECG Exercise Stress Testing and Framingham Risk Score in Chest Pain Patients PRIMARY SUPERVISOR NAME: Dr. Edward Tan DEPARTMENT:

More information

New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine

New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine Disclosures & Relevant Relationships I have nothing to disclose No financial conflicts Editor,

More information

Practical Applications of Nuclear Cardiology

Practical Applications of Nuclear Cardiology Practical Applications of Nuclear Cardiology a report by Dr Robert C Hendel President, American Society of Nuclear Cardiology, and Member, Midwest Heart Specialists Background Heart disease, specifically

More information

Use of a Prognostic Treadmill Score in Identifying Diagnostic Coronary Disease Subgroups

Use of a Prognostic Treadmill Score in Identifying Diagnostic Coronary Disease Subgroups Use of a Prognostic Treadmill Score in Identifying Diagnostic Coronary Disease Subgroups Leslee J. Shaw, PhD; Eric D. Peterson, MD, MPH; Linda K. Shaw, MS; Karen L. Kesler, MS; Elizabeth R. DeLong, PhD;

More information

Section 8: Clinical Exercise Testing. a maximal GXT?

Section 8: Clinical Exercise Testing. a maximal GXT? Section 8: Clinical Exercise Testing Maximal GXT ACSM Guidelines: Chapter 5 ACSM Manual: Chapter 8 HPHE 4450 Dr. Cheatham Outline What is the purpose of a maximal GXT? Who should have a maximal GXT (and

More information

Nurse practitioners: a safe and competent choice for stress testing in myocardial perfusion scintigraphy

Nurse practitioners: a safe and competent choice for stress testing in myocardial perfusion scintigraphy Nurse practitioners: a safe and competent choice for stress testing in myocardial perfusion scintigraphy K Standbridge, E Reyes, K Latus, SR Underwood, J Riley Imperial College London & Royal Brompton

More information

Atrial Fibrillation Prevention

Atrial Fibrillation Prevention Atrial Fibrillation Prevention Thierry C. Gillebert, MD, PhD, FESC Ghent University, Belgium ESC Global Scientific Activities SHA, Riyadh, Feb. 14, 2015 Mechanisms of AF Sinusal rhythm Mechanisms of AF

More information

Electrical Risk Stratification After STEMI

Electrical Risk Stratification After STEMI Electrical Risk Stratification After STEMI Peter Cheung, MD, FACC Section of Electrophysiology, Division of Cardiology, Scott & White Clinic Texas A&M Health Science Center Liew, Heart 2010; 96: 1086-94

More information

8/12/2015. Complimentary Webinar Series: Optimal Risk Benefit Ratio for Myocardial SPECT

8/12/2015. Complimentary Webinar Series: Optimal Risk Benefit Ratio for Myocardial SPECT Complimentary Webinar Series: Optimal Risk Benefit Ratio for Myocardial SPECT The IAEA is an independent intergovernmental science and technology based organization within the United Nations family Serves

More information

Assessing Cardiovascular Risk. Why Assess CVD Risk? Intensity of Treatment Should Match the CVD Risk.

Assessing Cardiovascular Risk. Why Assess CVD Risk? Intensity of Treatment Should Match the CVD Risk. Assessing Cardiovascular Risk Peter Ganz, MD Chief, Division of Cardiology Director, Center of Excellence in Vascular Research San Francisco General Hospital Maurice Eliaser Distinguished Professor of

More information

FFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium

FFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium FFR and CABG Emanuele Barbato, MD, PhD, FESC Cardiovascular Center Aalst, Belgium Background 8 th Coronary Physiology in the CathLab Course Revascularisation of intermediate stenosis can be targeted EITHER

More information

EMR Tutorial Acute Coronary Syndrome

EMR Tutorial Acute Coronary Syndrome EMR Tutorial Acute Coronary Syndrome How to find the Acute Coronary Syndrome AAA Home Page 1 of 26 Master Tool Bar Icon When the Template button is clicked you will be presented with the preference list.

More information

Cardiac Rehabilitation The Best Medicine for Your CAD Patients. James A. Stone

Cardiac Rehabilitation The Best Medicine for Your CAD Patients. James A. Stone James A. Stone BPHE, BA, MSc, MD, PhD, FRCPC, FAACVPR, FACC Clinical Professor of Medicine, University of Calgary Total Cardiology, Calgary Acknowledgements and Disclosures Acknowledgements Jacques Genest

More information

ESC/EASD Pocket Guidelines Diabetes, pre-diabetes and cardiovascular disease

ESC/EASD Pocket Guidelines Diabetes, pre-diabetes and cardiovascular disease Diabetes, prediabetes and cardiovascular disease Classes of recommendations Levels of evidence Recommended treatment targets for patients with diabetes and CAD Definition, classification and screening

More information

Renovascular Hypertension

Renovascular Hypertension Renovascular Hypertension Philip Stockwell, MD Assistant Professor of Medicine (Clinical) Warren Alpert School of Medicine Cardiology for the Primary Care Provider September 28, 201 Renovascular Hypertension

More information

CTA Coronary Angiography. Stents. Dimitrios N. Nikas, MD, PhD, FESC Interventional Cardiologist Ioannina University Hospital

CTA Coronary Angiography. Stents. Dimitrios N. Nikas, MD, PhD, FESC Interventional Cardiologist Ioannina University Hospital CTA Coronary Angiography Stents Dimitrios N. Nikas, MD, PhD, FESC Interventional Cardiologist Ioannina University Hospital I, DIMITRIOS N. NIKAS, MD, PHD, FESC, HAVE NO CONFLICT OF INTEREST TO DECLARE

More information

Always Start with PECO

Always Start with PECO Goals of This Course Be able to understand a study design (very basic concept) Be able to understand statistical concepts in a medical paper Be able to perform a data analysis Understanding: PECO study

More information

South African Cholesterol Guidelines Compared

South African Cholesterol Guidelines Compared South African Cholesterol Guidelines Compared Jacqueline van Schoor, Amayeza Info Centre While infectious diseases are currently the leading cause of death in South Africa, cardiovascular disease (CVD)

More information

Lipid Profiles of Acute Coronary Syndrome Patients Hospitalized in ICCU of Cipto Mangunkusumo Hospital

Lipid Profiles of Acute Coronary Syndrome Patients Hospitalized in ICCU of Cipto Mangunkusumo Hospital ORIGINAL ARTICLE Lipid Profiles of Acute Coronary Syndrome Patients Hospitalized in ICCU of Cipto Mangunkusumo Hospital Daulat Manurung ABSTRACT Aim: to see which component of the triad lipid that has

More information

COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION

COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION European Medicines Agency London, 19 July 2007 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR

More information

Prevention of Cardiovascular Disease in Children with Diabetes

Prevention of Cardiovascular Disease in Children with Diabetes Prevention of Cardiovascular Disease in Children with Diabetes Stephen R. Daniels, MD, PhD Department of Pediatrics University of Colorado School of Medicine The Children s Hospital Anschutz Medical Campus

More information

Nuclear Cardiology Fellow Rotation Cardiology Fellow Curriculum Penn State Milton S. Hershey Medical Center

Nuclear Cardiology Fellow Rotation Cardiology Fellow Curriculum Penn State Milton S. Hershey Medical Center Nuclear Cardiology Fellow Rotation Cardiology Fellow Curriculum Penn State Milton S. Hershey Medical Center OVERVIEW The cardiovascular fellow on the nuclear rotation will learn to interpret nuclear studies

More information

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION European Medicines Agency Pre-Authorisation Evaluation of Medicines for Human Use London, 25 September 2008 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE

More information

Principal Educational Goals

Principal Educational Goals Rotation: Nuclear Cardiology Director: Dr. Frank Bengel Faculty: Drs. Lewis Becker and Richard Wahl Rotation Hours: Mon to Fri, 9 am to 4 pm; Fellow may cover on "as needed" basis for other rotations.

More information

FFR and Acute Coronary Syndromes. William F. Fearon, MD Associate Professor Director, Interventional Cardiology Stanford University Medical Center

FFR and Acute Coronary Syndromes. William F. Fearon, MD Associate Professor Director, Interventional Cardiology Stanford University Medical Center FFR and Acute Coronary Syndromes William F. Fearon, MD Associate Professor Director, Interventional Cardiology Stanford University Medical Center Disclosure Statement of Financial Interest Within the past

More information

Running head: NONINVASIVE DIAGNOSIS OF CORONARY ARTERY DISEASE 1. Noninvasive Diagnosis of Coronary Artery Disease: A Literature Review and Case Study

Running head: NONINVASIVE DIAGNOSIS OF CORONARY ARTERY DISEASE 1. Noninvasive Diagnosis of Coronary Artery Disease: A Literature Review and Case Study Running head: NONINVASIVE DIAGNOSIS OF CORONARY ARTERY DISEASE 1 Noninvasive Diagnosis of Coronary Artery Disease: A Literature Review and Case Study November 13, 2012 CORONARY ARTERY DISEASE 2 Abstract

More information

HYPERCHOLESTEROLAEMIA STATIN AND BEYOND

HYPERCHOLESTEROLAEMIA STATIN AND BEYOND HYPERCHOLESTEROLAEMIA STATIN AND BEYOND Andrea Luk Division of Endocrinology Department of Medicine & Therapeutics The Chinese University of Hong Kong HA Convention 4 May 2016 Statins reduce CVD and all-cause

More information

Peripheral Vascular Disease

Peripheral Vascular Disease Peripheral Vascular Disease Evaluation and Management Considerations Mark R. Gazall, D.O. Vascular/Thoracic Surgery Grandview/Southview Medical Centers Background Peripheral arterial occlusive disease

More information

The author has no disclosures

The author has no disclosures Mary Bradbury, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Surgery September 18, 2012 Mary.bradbury@inova.org This presentation will discuss unlabeled and investigational use of products The author

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE 1 NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Guideline title SCOPE Hypertension: clinical management of primary hypertension in adults 1.1 Short title Hypertension (partial update) 2 The remit

More information

Coronary Calcium Scoring and Risk Assessment

Coronary Calcium Scoring and Risk Assessment Norbert Wilke, MD, F.A.C.C., F.E.S.C. Associate Professor of Radiology Associate Professor of Medicine Courtesy to Franz von Ziegler, MD Univ. of Munich, Germany Coronary Calcium Scoring and Risk Assessment

More information

A CLOSER L OOK AT A JOINT PROJECT BETWEEN T HE A MERICAN H EART A SSOCIATION AND T HE N ATIONAL P HARMACEUTICAL C OUNCIL

A CLOSER L OOK AT A JOINT PROJECT BETWEEN T HE A MERICAN H EART A SSOCIATION AND T HE N ATIONAL P HARMACEUTICAL C OUNCIL A CLOSER L OOK AT Americans pay $53.4 billion each year for medical care of heart disease. An additional $47.4 billion is lost due to premature death and lower productivity. A JOINT PROJECT BETWEEN T HE

More information

ORIGINAL ARTICLES. The prognostic value of ECG-gated SPECT imaging in patients undergoing stress Tc-99m sestamibi myocardial perfusion imaging

ORIGINAL ARTICLES. The prognostic value of ECG-gated SPECT imaging in patients undergoing stress Tc-99m sestamibi myocardial perfusion imaging ORIGINAL ARTICLES The prognostic value of ECG-gated SPECT imaging in patients undergoing stress Tc-99m sestamibi myocardial perfusion imaging Mark I. Travin, MD, FACC, a Gary V. Heller, MD, PhD, FACC,

More information

Specific Basic Standards for Osteopathic Fellowship Training in Cardiology

Specific Basic Standards for Osteopathic Fellowship Training in Cardiology Specific Basic Standards for Osteopathic Fellowship Training in Cardiology American Osteopathic Association and American College of Osteopathic Internists BOT 07/2006 Rev. BOT 03/2009 Rev. BOT 07/2011

More information

MEDICAL POLICY No R0 COMPUTERIZED TOMOGRAPHIC ANGIOGRAPHY CORONARY ARTERIES (CCTA)

MEDICAL POLICY No R0 COMPUTERIZED TOMOGRAPHIC ANGIOGRAPHY CORONARY ARTERIES (CCTA) COMPUTERIZED TOMOGRAPHIC ANGIOGRAPHY CONARY ARTERIES (CCTA) Effective Date: December 1, 2015 Review Dates: 11/15 Date Of Origin: November 11, 2015 Status: New I. POLICY/CRITERIA The following diagnostic

More information

ERECTILE DYSFUNCTION THE IMPACT OF DIABETES ON PROGRESSION AND TREATMENT

ERECTILE DYSFUNCTION THE IMPACT OF DIABETES ON PROGRESSION AND TREATMENT UW MEDICINE MEN S HEALTH CENTER ERECTILE DYSFUNCTION THE IMPACT OF DIABETES ON PROGRESSION AND TREATMENT THOMAS J. WALSH, MD, MS OCTOBER 8 TH, 2016 2016 WASHINGTON DIABETES SUMMIT DISCLOSURE INFORMATION

More information

AMERICAN SOCIETY OF NUCLEAR CARDIOLOGY INFORMATION STATEMENT

AMERICAN SOCIETY OF NUCLEAR CARDIOLOGY INFORMATION STATEMENT AMERICAN SOCIETY OF NUCLEAR CARDIOLOGY INFORMATION STATEMENT Cost-effectiveness of myocardial perfusion imaging: A summary of the currently available literature Roger D. Des Prez, MD, Leslee J. Shaw, PhD,

More information

INTRODUCTION TO EECP THERAPY

INTRODUCTION TO EECP THERAPY INTRODUCTION TO EECP THERAPY is an FDA cleared, Medicare approved, non-invasive medical therapy for the treatment of stable and unstable angina, congestive heart failure, acute myocardial infarction, and

More information

Ischemic Heart Disease: Angina Pectoris

Ischemic Heart Disease: Angina Pectoris Ischemic Heart Disease: Angina Pectoris Robert J. Straka, Pharm.D. FCCP Associate Professor University of Minnesota College of Pharmacy Minneapolis, Minnesota, USA strak001@umn.edu Learning Objectives

More information

Predictive Value of the Framingham Risk Score in Identifying High Cardiovascular Risk

Predictive Value of the Framingham Risk Score in Identifying High Cardiovascular Risk 4 Internacional Journal of Cardiovascular Sciences. 2015;28(1):4-8 ORIGINAL MANUSCRIPT Predictive Value of the Framingham Risk Score in Identifying High Cardiovascular Risk Priscila Valente Fernandes 1,

More information

Platelet Function Testing vs Genotyping : Focus on Pharmacogenomics of Clopidogrel. Kiyuk Chang, M.D., Ph.D.

Platelet Function Testing vs Genotyping : Focus on Pharmacogenomics of Clopidogrel. Kiyuk Chang, M.D., Ph.D. Platelet Function Testing vs Genotyping : Focus on Pharmacogenomics of Clopidogrel Kiyuk Chang, M.D., Ph.D. Cardiovascular Center & Cardiology Division Seoul St. Mary s Hospital The Catholic University

More information