Nuclear medicine

In the current issue of Cardiovascular Innovations and Applications volume 4, issue 1, pp. 31-42(12) ;Talal Alzahrani, MD, Ahmed Tashkandi, MD, Abdullah Sarkar, MD, Claudio Smuclovisky, MD, James P. Earls, MD and Andrew D. Choi, MD, from the Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA; Department of Medicine, University of Miami, Miami, FL, USA; Diagnostic Imaging Center.

Practical clinical applications

Holy Cross Hospital, Fort Lauderdale, FL, USA and the Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA consider practical clinical applications of cardiac computed tomography-derived fractional flow reserve.

In the past decade, advances in coronary computed tomography angiography (CTA) technology have resulted in high sensitivity and negative predictive value in detecting coronary artery disease (CAD) compared with invasive coronary angiography, particularly for patients with mild or severe stenosis. However; anatomical evaluation of CAD by CTA has modest specificity for patients with intermediate-grade stenoses.

Computed tomography angiography

The recent development of the use of cardiac computed tomography-derived fractional flow reserve (FFR-CT) seeks to address this gap as a proposed method of functional assessment of CAD by CTA. therefore In this article the authors mix common clinical cases with the current technical methods; validation, outcomes, and registry studies as well as the technical, financial and research limitations of FFRCT analysis to guide the cardiac imaging specialist in evaluating this technique.

FFR-CT analysis may help reduce additive functional testing for the smaller proportion of patients with intermediate stenosis undergoing coronary CTA where the atherosclerosis significance is uncertain. Fractional flow reserve-computed tomography (FFR-CT) is still in the early stages of clinical implementation in the United States; but it is already changing clinical practice as a non-invasive alternative to diagnosing patients with chest pain.

Food and Drug Administration

Approved by the U.S. Food and Drug Administration (FDA) in November 2014, the technology provides both anatomical and functional assessment of the coronary arteries; a task no other method has accomplished to date.  DAIC spoke with three users of the Heart Flow FFR-CT technology; each in various stages of clinical practice:Recent data suggest, however, that many of these patients are being sent to the cath lab unnecessarily.
A three-year retrospective study published in the June 2014 American Heart Journal found that nearly 60 percent of 661,063 patients referred for elective angiography had non-obstructive coronary artery disease (CAD) nearly two-thirds of these patients sent to the cath lab did not have a clinically significant coronary disease. Because “We’re sending two out of three patients to get an invasive; expensive procedure for no reason,” Min told DAIC.