Evidence-based Cardiovascular Imaging

A. Understand the principles of technology assessment.

Technology Assessment for Radiologists Jonathan H. Sunshine and Kimberly E. Applegate Radiology February 2004 230:309-314; doi:10.1148/radiol.2302031277
Study Design for Concurrent Development, Assessment, and Implementation of New Diagnostic Imaging Technology M.G. Myriam Hunink and Gabriel P. Krestin Radiology March 2002 222:604-614; Published online February 1, 2002, doi:10.1148/radiol.2223010335
B. Be aware of cardiovascular risk factors with an understanding of the Framingham risk score.
Value and Limitations of Existing Scores for the Assessment of Cardiovascular Risk: A Review for Clinicians Cooney, Marie Therese, Dudina, Alexandra L., Graham, Ian M. J Am Coll Cardiol 2009 54: 1209-1227
Emerging Risk Factors for Atherosclerotic Vascular Disease: A Critical Review of the Evidence Daniel G. Hackam, Sonia S. Anand JAMA. 2003;290(7):932-940 doi:10.1001/jama.290.7.932
Coronary calcium: new insights, recent data, and clinical role. Curr Cardiol Rep. 2013 Jan;15(1):325. doi: 10.1007/s11886-012-0325-3

C. Understand the imaging risk markers for atheromatous disease, notably coronary calcium score on CT and intimo-medial thickness on carotid ultrasound.
Carotid Intima-Media Thickness, Plaques, and Cardiovascular Disease Risk: Implications for Preventive Cardiology Guidelines Stein, James H., Johnson, Heather M. J Am Coll Cardiol 2010 55: 1608-1610
Role of computed tomography in risk assessment for coronary heart disease Tarun K Mittal, Mahmoud Barbir, and Michael Rubens Postgrad Med J. 2006 October; 82(972): 664–671. doi: 10.1136/pgmj.2005.043612
D. Understand how the calcium score affects management above and beyond the Framingham risk score
Coronary Artery Calcium Score and Risk Classification for Coronary Heart Disease Prediction Tamar S. Polonsky, Robyn L. McClelland, Neal W. Jorgensen, Diane E. Bild, Gregory L. Burke, Alan D. Guerci, Philip Greenland JAMA. 2010;303(16):1610-1616. doi:10.1001/jama.2010.461
What Makes a Good Predictor? The Evidence Applied to Coronary Artery Calcium Score John P. A. Ioannidis, Ioanna Tzoulaki JAMA. 2010;303(16):1646-1647. doi:10.1001/jama.2010.503
Assessment of Claims of Improved Prediction Beyond the Framingham Risk Score Ioanna Tzoulaki, George Liberopoulos, John P. A. Ioannidis JAMA. 2009;302(21):2345-2352. doi:10.1001/jama.2009.1757
E. Appreciate the arguments for and against screening for cardiovascular disease using coronary calcium score
Noninvasive Screening for Coronary Artery Disease With Computed Tomography Is Useful Melvin E. Clouse Circulation. 2006;113:125-146, doi:10.1161/CIRCULATIONAHA.104.478354
How useful is computed tomography for screening for coronary artery disease? Screening for coronary artery disease with electron-beam computed tomography is not useful. (Abstract) Chen, J; Krumholz, MH Circulation. 2006;113:125-146, doi:10.1161/CIRCULATIONAHA.104.478354
Is There a Role for Coronary Artery Calcium Scoring for Management of Asymptomatic Patients at Risk for Coronary Artery Disease?: Clinical Risk Scores Are Sufficient To Define Primary Prevention Treatment Strategies Among Asymptomatic Patients Charlotte Andersson, MD, PhD^1,^2,³ and Ramachandran S. Vasan, MD.^1,²Circ Cardiovasc Imaging. 2014 Mar; 7(2): 390–397.
F. Appreciate the competing modalities for detection of chronic ischemic heart disease including myocardial perfusion scintigraphy, stress echo, stress MRI, cardiac CT, exercise ECG and PET
One-stop shop cardiovascular imaging Stefan Zimmerman, MD, and Saurabh Jha, MBBS Applied Radiology, Volume 40, Number 1, January 2011
Prognostic Value of Cardiac Magnetic Resonance Stress Tests: Adenosine Stress Perfusion and Dobutamine Stress Wall Motion Imaging Cosima Jahnke, Eike Nagel, Rolf Gebker, Thomas Kokocinski, Sebastian Kelle, Robert Manka, Eckart Fleck, and Ingo Paetsch Circulation. 2007;115:1769-1776, published online before print March 12 2007, doi:10.1161/CIRCULATIONAHA.106.652016
MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial Juerg Schwitter, Christian M. Wacker, Albert C. van Rossum, Massimo Lombardi, Nidal Al-Saadi, Hakan Ahlstrom, Thorsten Dill, Henrik B.W. Larsson, Scott D. Flamm, Moritz Marquardt, and Lars Johansson Eur Heart J (2008) 29(4): 480-489 first published online January 21, 2008 doi:10.1093/eurheartj/ehm617
Assessment of Myocardial Perfusion in Coronary Artery Disease by Magnetic Resonance : A Comparison With Positron Emission Tomography and Coronary Angiography J. Schwitter, D. Nanz, S. Kneifel, K. Bertschinger, M. Büchi, P. R. Knüsel, B. Marincek, T. F. Lüscher, and G. K. von Schulthess Circulation. 2001;103:2230-2235, doi:10.1161/01.CIR.103.18.2230
G. Appreciate the competing modalities for detection of acute coronary syndrome
Detecting Acute Coronary Syndrome in the Emergency Department With Cardiac Magnetic Resonance Imaging Raymond Y. Kwong, Adam E. Schussheim, Suresh Rekhraj, Anthony H. Aletras, Nancy Geller, Janice Davis, Timothy F. Christian, Robert S. Balaban, and Andrew E. Arai Circulation. 2003;107:531-537, published online before print January 6 2003, doi:10.1161/01.CIR.0000047527.11221.29
Testing of Low-Risk Patients Presenting to the Emergency Department With Chest Pain: A Scientific Statement From the American Heart Association Ezra A. Amsterdam, J. Douglas Kirk, David A. Bluemke, Deborah Diercks, Michael E. Farkouh, J. Lee Garvey, Michael C. Kontos, James McCord, Todd D. Miller, Anthony Morise, L. Kristin Newby, Frederick L. Ruberg, Kristine Anne Scordo, Paul D. Thompson, and on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council on Cardiovascular Nursing, and Interdisciplinary Council on Quality of Care and Outcomes Research Circulation. 2010;122:1756-1776, published online before print July 26 2010, doi:10.1161/CIR.0b013e3181ec61df
Acute Coronary Syndrome: Emerging Tools for Diagnosis and Risk Assessment Scirica, Benjamin M. J Am Coll Cardiol 2010 55: 1403-1415
H. Have an understanding for the clinical contexts in which a high negative predictive value is important for those in which a high positive predictive value is necessary.
Cardiac CT, MR, SPECT, ECHO, and PET: What test, when? Halia Al-Shehri, MBChB, Gary Small, MRCP, and Benjamin J.W. Chow, MD, FRCPC, FACC, FASNC, FSCCT Applied Radiology, Volume 40, Number 05, May 2011
Influence of coronary artery disease prevalence on predictive values of coronary CT angiography: a meta-regression analysis Peter Schlattmann, Georg M. Schuetz and Marc Dewey European Radiology Volume 21, Number 9, 1904-1913, DOI: 10.1007/s00330-011-2142-2

I. Be aware of some of the research comparing cardiac CT with myocardial perfusion imaging.

Diagnostic Performance of Coronary Angiography by 64-Row CT
Julie M. Miller, M.D., Carlos E. Rochitte, M.D., Marc Dewey, M.D., Armin Arbab-Zadeh, M.D., Hiroyuki Niinuma, M.D., Ph.D., Ilan Gottlieb, M.D., Narinder Paul, M.D., Melvin E. Clouse, M.D., Edward P. Shapiro, M.D., John Hoe, M.D., Albert C. Lardo, Ph.D., David E. Bush, M.D., Albert de Roos, M.D., Christopher Cox, Ph.D., Jeffery Brinker, M.D., and João A.C. Lima, M.D.
N Engl J Med 2008; 359:2324-2336 November 27, 2008

Coronary CT angiography versus standard evaluation in acute chest pain
N Engl J Med. 2012 Jul 26;367(4):299-308. doi: 10.1056/NEJMoa1201161.
Hoffmann U¹, Truong QA, Schoenfeld DA, Chou ET, Woodard PK, Nagurney JT, Pope JH, Hauser TH, White CS, Weiner SG, Kalanjian S, Mullins ME, Mikati I, Peacock WF, Zakroysky P, Hayden D, Goehler A, Lee H, Gazelle GS, Wiviott SD, Fleg JL, Udelson JE; ROMICAT-II Investigators.

Chest Pain in the Emergency Department: Role of Multidetector CT
Charles S. White and Dick Kuo
Radiology December 2007 245:672-681; doi:10.1148/radiol.2453061481

Myocardial Perfusion Imaging and Multidetector Computed Tomographic Coronary Angiography: Appropriate for All Patients With Suspected Coronary Artery Disease?
Dorbala, Sharmila, Hachamovitch, Rory, Di Carli, Marcelo F.
J Am Coll Cardiol 2006 48: 2515-2517

Evaluation of a “Triple Rule-Out” Coronary CT Angiography Protocol: Use of 64-Section CT in Low-to-Moderate Risk Emergency Department Patients Suspected of Having Acute Coronary Syndrome
Kevin M. Takakuwa and Ethan J. Halpern
Radiology August 2008 248:438-446; doi:10.1148/radiol.2482072169

Coronary Computed Tomography Angiography for Early Triage of Patients With Acute Chest Pain: The ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) Trial
Hoffmann, Udo, Bamberg, Fabian, Chae, Claudia U., Nichols, John H., Rogers, Ian S., Seneviratne, Sujith K., Truong, Quynh A., Cury, Ricardo C., Abbara, Suhny, Shapiro, Michael D., Moloo, Jamaluddin, Butler, Javed, Ferencik, Maros, Lee, Hang, Jang, Ik-Kyung, Parry, Blair A., Brown, David F., Udelson, James E., Achenbach, Stephan, Brady, Thomas J., Nagurney, John T.
J Am Coll Cardiol 2009 53: 1642-1650

J. Understand the controversies pertaining to cardiac CT particularly with regards to its costs and the costs of treating incidental findings.

Pay Now, Benefits May Follow — The Case of Cardiac Computed Tomographic Angiography
Rita F. Redberg, M.D., and Judith Walsh, M.D., M.P.H.
N Engl J Med 2008; 359:2309-2311November 27, 2008

CT coronary angiography vs. invasive coronary angiography in CHD
GMS Health Technol Assess. 2012;8:Doc02. doi: 10.3205/hta000100. Epub 2012 Apr 16.
Gorenoi V¹, Schönermark MP, Hagen A.

Economic Considerations for Coronary CT Angiography (Abstract)
James K. Min, Abhishek Sharma and Danielle Nicolo
Current Cardiovascular Imaging Reports Volume 3, Number 6, 390-395, DOI: 10.1007/s12410-010-9050-8

K. Appreciate the role of late gadolinium MRI in risk stratifying patients with various forms of cardiomyopathy. Understand the additional prognostic information offered.

Cardiovascular Magnetic Resonance, Fibrosis, and Prognosis in Dilated Cardiomyopathy
Assomull, Ravi G., Prasad, Sanjay K., Lyne, Jonathan, Smith, Gillian, Burman, Elizabeth D., Khan, Mohammed, Sheppard, Mary N., Poole-Wilson, Philip A., Pennell, Dudley J.
J Am Coll Cardiol 2006 48: 1977-1985

Cardiac MRI in the diagnosis of complications of myocardial infarction.
Diagn Interv Imaging. 2012 Jul;93(7-8):578-85. doi: 10.1016/j.diii.2012.05.012. Epub 2012 Jul 6.
Flavian A¹, Carta F, Thuny F, Bernard M, Kober F, Moulin G, Varoquaux A, Jacquier A.

Differentiation of Heart Failure Related to Dilated Cardiomyopathy and Coronary Artery Disease Using Gadolinium-Enhanced Cardiovascular Magnetic Resonance
J.A. McCrohon, J.C.C. Moon, S.K. Prasad, W.J. McKenna, C.H. Lorenz, A.J.S. Coats, and D.J. Pennell
Circulation. 2003;108:54-59, published online before print June 23 2003, doi:10.1161/01.CIR.0000078641.19365.4C

L. Understand the seminal study involving survival analysis of patients with hypertrophic cardiomyopathy and scar as detected on late gadolinium MRI.

Toward clinical risk assessment inhypertrophic cardiomyopathy withgadolinium cardiovascular magnetic resonance
Moon, James C. C., McKenna, William J., McCrohon, Jane A., Elliott, Perry M., Smith, Gillian C., Pennell, Dudley J.
J Am Coll Cardiol 2003 41: 1561-1567

Myocardial Fibrosis as an Early Manifestation of Hypertrophic Cardiomyopathy
Carolyn Y. Ho, M.D., Begoña López, Ph.D., Otavio R. Coelho-Filho, M.D., Neal K. Lakdawala, M.D., Allison L. Cirino, M.S., C.G.C., Petr Jarolim, M.D., Ph.D., Raymond Kwong, M.D., Arantxa González, Ph.D., Steven D. Colan, M.D., J.G. Seidman, Ph.D., Javier Díez, M.D., Ph.D., and Christine E. Seidman, M.D.
N Engl J Med 2010; 363:552-563August 5, 2010

M. Appreciate how MRI guides the decision to revascularize and how this is superior to PET and myocardial perfusion imaging.

The Use of Contrast-Enhanced Magnetic Resonance Imaging to Identify Reversible Myocardial Dysfunction
Raymond J. Kim, M.D., Edwin Wu, M.D., Allen Rafael, M.D., Enn-Ling Chen, Ph.D., Michele A. Parker, M.S., Orlando Simonetti, Ph.D., Francis J. Klocke, M.D., Robert O. Bonow, M.D., and Robert M. Judd, Ph.D.
N Engl J Med 2000; 343:1445-1453November 16, 2000

Transmural Extent of Acute Myocardial Infarction Predicts Long-Term Improvement in Contractile Function
Kelly M. Choi, Raymond J. Kim, George Gubernikoff, John D. Vargas, Michelle Parker, and Robert M. Judd
Circulation. 2001;104:1101-1107, published online before print August 13 2001, doi:10.1161/hc3501.096798

Impact of Unrecognized Myocardial Scar Detected by Cardiac Magnetic Resonance Imaging on Event-Free Survival in Patients Presenting With Signs or Symptoms of Coronary Artery Disease
Raymond Y. Kwong, Anna K. Chan, Kenneth A. Brown, Carmen W. Chan, H. Glenn Reynolds, Sui Tsang, and Roger B. Davis
Circulation. 2006;113:2733-2743, published online before print June 5 2006, doi:10.1161/CIRCULATIONAHA.105.570648

N. Understand how MRI functions as a biomarker for iron involvement of the heart and how this has revolutionized survival of patients with thalassemia.

History and Current Impact of Cardiac Magnetic Resonance Imaging on the Management of Iron Overload
John C. Wood
Circulation. 2009;120:1937-1939, published online before print November 2 2009, doi:10.1161/CIRCULATIONAHA.109.907196

Cardiac T2* Magnetic Resonance for Prediction of Cardiac Complications in Thalassemia Major
P. Kirk, M. Roughton, J.B. Porter, J.M. Walker, M.A. Tanner, J. Patel, D. Wu, J. Taylor, M.A. Westwood, L.J. Anderson, and D.J. Pennell
Circulation. 2009;120:1961-1968, published online before print October 2 2009, doi:10.1161/CIRCULATIONAHA.109.874487

O. Understand how MRI helps with the decision who should get an ICD and who should receive cardiac resynchronization therapy.

Magnetic Resonance Assessment of the Substrate for Inducible Ventricular Tachycardia in Nonischemic Cardiomyopathy
Saman Nazarian, David A. Bluemke, Albert C. Lardo, Menekhem M. Zviman, Stanley P. Watkins, Timm L. Dickfeld, Glenn R. Meininger, Ariel Roguin, Hugh Calkins, Gordon F. Tomaselli, Robert G. Weiss, Ronald D. Berger, João A.C. Lima, and Henry R. Halperin
Circulation. 2005;112:2821-2825, doi:10.1161/CIRCULATIONAHA.105.549659

Infarct Tissue Heterogeneity by Magnetic Resonance Imaging Identifies Enhanced Cardiac Arrhythmia Susceptibility in Patients With Left Ventricular Dysfunction
André Schmidt, Clerio F. Azevedo, Alan Cheng, Sandeep N. Gupta, David A. Bluemke, Thomas K. Foo, Gary Gerstenblith, Robert G. Weiss, Eduardo Marbán, Gordon F. Tomaselli, João A.C. Lima, and Katherine C. Wu
Circulation. 2007;115:2006-2014, published online before print March 26 2007, doi:10.1161/CIRCULATIONAHA.106.653568

Nonechocardiographic Imaging in Evaluation for Cardiac Resynchronization Therapy (Abstract)
Wael AlJaroudi, Ji Chen, Wael A. Jaber, Steven G. Lloyd, Manuel D. Cerqueira, and Thomas Marwick
Circ Cardiovasc Imaging. 2011;4:334-343, doi:10.1161/CIRCIMAGING.111.963504

Myocardial Fibrosis Predicts Appropriate Device Therapy in Patients With Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death (Abstract)
Iles, Leah, Pfluger, Heinz, Lefkovits, Lisa, Butler, Michelle J., Kistler, Peter M., Kaye, David M., Taylor, Andrew J.
J Am Coll Cardiol 2011 57: 821-828

P. Understand how CMR reduces sample size in clinical trial which use CMR parameters as end points, in comparison to echo

Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance. Are they interchangeable?
N.G Bellenger, M.I Burgess, S.G Ray, A Lahiri, A.J.S Coats, J.G.F Cleland, and D.J Pennell
Eur Heart J (2000) 21(16): 1387-1396 doi:10.1053/euhj.2000.2011

Reduction in sample size for studies of remodeling in heart failure by the use of cardiovascular magnetic resonance (Abstract)
Bellenger NG, Davies LC, Francis JM, Coats AJ, Pennell DJ.
J Cardiovasc Magn Reson. 2000;2(4):271-8.

Evidence-based Cardiovascular Imaging

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