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PURPOSE: To characterize the recovery of diagnostic cardiovascular procedure volumes in U.S. and non-U.S. facilities in the year following the initial COVID-19 outbreak. MATERIALS AND METHODS: The International Atomic Energy Agency (IAEA) coordinated a worldwide study called the IAEA Noninvasive Cardiology Protocols Study of COVID-19 2 (INCAPS COVID 2), collecting data from 669 facilities in 107 countries, including 93 facilities in 34 U.S. states, to determine the impact of the pandemic on diagnostic cardiovascular procedure volumes. Participants reported volumes for each diagnostic imaging modality used at their facility for March 2019 (baseline), April 2020, and April 2021. This secondary analysis of INCAPS COVID 2 evaluated differences in changes in procedure volume between U.S. and non-U.S. facilities and among U.S. regions. Factors associated with return to prepandemic volumes in the United States were also analyzed in a multivariable regression analysis. RESULTS: Reduction in procedure volumes in April 2020 compared with baseline was similar for U.S. and non-U.S. facilities (-66% vs -71%, P = .27). U.S. facilities reported greater return to baseline in April 2021 than did all non-U.S. facilities (4% vs -6%, P = .008), but there was no evidence of a difference when comparing U.S. facilities with non-U.S. high-income country (NUHIC) facilities (4% vs 0%, P = .18). U.S. regional differences in return to baseline were observed between the Midwest (11%), Northeast (9%), South (1%), and West (-7%, P = .03), but no studied factors were significant predictors of 2021 change from prepandemic baseline. CONCLUSION: The reductions in cardiac testing during the early pandemic have recovered within a year to prepandemic baselines in the United States and NUHICs, while procedure volumes remain depressed in lower-income countries.Keywords: SPECT, Cardiac, Epidemiology, Angiography, CT Angiography, CT, Echocardiography, SPECT/CT, MR Imaging, Radionuclide Studies, COVID-19, Cardiovascular Imaging, Diagnostic Cardiovascular Procedure, Cardiovascular Disease, Cardiac Testing Supplemental material is available for this article. © RSNA, 2023.

Abstract This expert consensus statement from the Society of Cardiovascular Computed Tomography (SCCT) provides an evidence synthesis on the use of computed tomography (CT) imaging for diagnosis and risk stratification of coronary artery disease in women. From large patient and population cohorts of asymptomatic women, detection of any coronary artery calcium that identifies females with a 10-year atherosclerotic cardiovascular disease risk of >7.5% may more effectively triage women who may benefit from pharmacologic therapy. In addition to accurate detection of obstructive coronary artery disease (CAD), CT angiography (CTA) identifies nonobstructive atherosclerotic plaque extent and composition which is otherwise not detected by alternative stress testing modalities. Moreover, CTA has superior risk stratification when compared to stress testing in symptomatic women with stable chest pain (or equivalent) symptoms. For the evaluation of symptomatic women both in the emergency department and the outpatient setting, there is abundant evidence from large observational registries and multi-center randomized trials, that CT imaging is an effective procedure. Although radiation doses are far less for CT when compared to nuclear imaging, radiation dose reduction strategies should be applied in all women undergoing CT imaging. Effective and appropriate use of CT imaging can provide the means for improved detection of at-risk women and thereby focus preventive management resulting in long-term risk reduction and improved clinical outcomes. [ABSTRACT FROM AUTHOR]

Over 6 million patients in the United States of America have congestive heart failure. Fifty percent of those patients have heart failure with preserved ejection fraction (HFpEF). Transthyretin (TTR) Amyloidosis (aTTR) has become a common cause of HFpEF in the United States. Due to high specificity and sensitivity. Technetium Pyrophosphate Scintigraphy or PYP scan has become the corner stone for diagnosis of TTR amyloidosis. The Incidence of TTR amyloidosis is unknown for equivocal PYP scans. This retrospective review of equivocal Technetium-99 (Tc-99m) PYP scans was to determine the utility of endomyocardial biopsy (EMB) following equivocal PYP scan after IRB approval. Planar and SPECT processed Tc99m-PYP scans for aTTR amyloidosis done at Deborah Heart and Lung Center from 2017-2022 and in nuclear laboratory database were reviewed. Scans were done at 1hr delayed followed by 3hr delayed scan unless clearly positive. Results were categorized into 3 groups: positive, negative and equivocal. Positive and negative results were then excluded from the analysis. Electronic medical record system (EMR) was then reviewed of all equivocal Tc-99m-PYP scan patients to identify those who underwent EMB. EMB reports were then reviewed and tabulated as positive or negative for aTTR amyloidosis. A total of 150 patients underwent Tc-99m-PYP studies for aTTR amyloidosis of which 47 were equivocal. Demographical data of the equivocal patients revealed 89% were white and 10% black (42 and 5 respectively). Male to female ratio was 1:1. Average age was 73 years (46-90). Coronary artery disease was present in 56% (26) of patients. Hypertension was in 84% (39) of patients. Diabetes was in 43% (20) of patients. Average ejection fraction was 53%. And 6% (3) were on inotropic support. Repeat PYP was offered to all equivocal patients. Four patients underwent repeat PYP 75% of these were not suggestive of aTTR amyloidosis. EMB was also offered to all the equivocal patients. However due to age and comorbidities patients did not follow up with biopsies. Of the 47 patients, 15 patients underwent EMB. Of the 15 EMBs; 14 were negative and 1 was positive for aTTR amyloidosis. Ninety three percent of the patients had a negative EMB following equivocal PYP scans. All 47 patients, underwent clonal analysis. Thirty percent of the patients had abnormal hematological clonal analysis. All patients with abnormal clonal analysis were evaluated by hematology. None of the abnormal clonal analysis patients had plasma cell dyscrasias on confirmatory testing. Our data suggests that incidence of TTR amyloidosis is low for patients undergoing EMB for equivocal PYP scans. Given the low yield perhaps a non-invasive strategy such as cardiac MRI or repeating a PYP scan at an interval is safer for this patient population. Further larger, prospective studies are needed to confirm our findings to reassess role of EMB in equivocal PYP scans. [ABSTRACT FROM AUTHOR]

Aim: Safety-net hospitals (SNHs) look after a higher proportion of uninsured patients and are often located in deprived areas. This study aimed to determine whether there are differences in the clinical characteristics, treatments and outcomes of patients presenting with acute myocardial infarction (AMI) in SNHs versus non-SNHs (N-SNHs).Methods: All hospitalizations with a principal diagnosis of AMI in the United States' National Inpatient Sample between 2016 and 2019 were stratified by safety-net hospital status. Multivariable logistic regression with adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) was conducted to investigate invasive management and clinical outcomes.Results: A total of 2,544,009 weighted discharge records were analyzed, including 601,719 records from SNHs (23.7 %). Compared with N-SNHs, SNH AMI patients were younger (median 66 years vs. 67 years, p < 0.001), and had a higher proportion in the lowest quartile of median household income (37.3 % vs. 28.5 %, p < 0.001). Patients from SNHs were less likely to receive coronary angiography (aOR 0.92, 95 % CI 0.91-0.93, p < 0.001), percutaneous coronary intervention (aOR 0.94, 95 % CI 0.93-0.95, p < 0.001), and coronary artery bypass grafting (aOR 0.93, 95 % CI 0.92-0.94, p < 0.001). In addition, they had increased all-cause mortality (aOR 1.11, 95 % CI 1.09-1.12, p < 0.001), major adverse cardiovascular/cerebrovascular events (composite of mortality, stroke and reinfarction) (aOR 1.11, 95 % CI 1.09-1.12, p < 0.001), and stroke (aOR 1.11, 95 % CI 1.08-1.14, p < 0.001), while there was no difference in major bleeding (aOR 1.02, 95 % CI 1.00-1.04, p = 0.107).Conclusion: Among AMI patients, treatment in SNHs was associated with lower utilization of coronary angiography and revascularization and worse clinical outcomes. [ABSTRACT FROM AUTHOR]

Aim: This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients.Methods: A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered.Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended. [ABSTRACT FROM AUTHOR]

Background: Cardiac Computed Tomography (CCT) is increasingly used for evaluation of congenital heart disease (CHD) in patients of all ages. Pediatric and adult congenital heart disease (ACHD) surgical programs require high quality CCT imaging as part of the multimodality imaging support expected of comprehensive care centers. Despite these expectations, there are no benchmarks or defined programmatic elements specific to the performance of CCT in patients with CHD. To address this deficit, this manuscript is written by a group of current CHD CCT practitioners and provides a collective opinion regarding the clinical components required, and essential resources needed, to deliver a comprehensive CCT CHD imaging program. Resource allocation was divided into CCT technology, imaging technologist, physician and programmatic support. The group is inclusive of pediatric and adult cardiologists and radiologists and includes practitioners from high and lower resourced programs and countries. Imaging settings are inclusive of academic and private practice, heart centers and combined radiology/cardiology service lines. Challenges and areas for future advocacy to support this growing specialty are proposed to improve performance standards that will consider the expected widespread variation in technical and staffing resources, skillsets, and practice settings for CT in CHD., Summary: High quality cardiovascular computed tomography is an essential component of pediatric and adult congenital programs and surgical centers. Program growth outpaces resource allocation in most institutions. This opinion paper outlines essential components for technical, technologist and physician resources and programmatic support to develop and maintain a successful CCT in CHD program. Although a small component of most cardiac imaging programs, it is an essential component particularly in complex cases. Institutional and imaging societal commitment is essential to support this emerging field at highest quality., Competing Interests: Declaration of competing interest There are no relevant conflicts of interest for authors of this manuscript related to the content submitted., (Copyright © 2025. Published by Elsevier Inc.)