November 9th, 2011
Obstructive Lesions Found in Patients with Calcium Scores of Zero
Larry Husten, PHD
A small but significant number of symptomatic patients with calcium scores of zero have obstructive coronary artery disease (CAD), according to a new study published in the Journal of the American College of Cardiology. Todd Villines and colleagues studied 10,037 symptomatic patients without known CAD enrolled in the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry who […]
November 8th, 2011
Financial Incentives Increase Use of Stress Tests
Larry Husten, PHD
Following coronary revascularization, patients are more likely to undergo cardiac stress testing if their physician has a financial interest in the test, according to a new study published in JAMA. Bimal Shah and colleagues examined insurance data from 17,847 patients who underwent revascularization, dividing their physicians into three groups: those who billed for technical and professional fees, […]
August 28th, 2011
Anatomical vs. Physiological Assessment of Coronary Artery Disease
Stephen Fleet, MD
Just as the great voleur Willie Sutton robbed banks because “that’s where the money is,” why don’t we just look for coronary artery disease (CAD) directly in the coronary arteries? At the ESC meeting today in Paris, Bharati Shivalkar of Belgium reviewed the assessment of CAD utilizing coronary CT angiography (anatomical) vs. the usual standard of care, stress […]
May 23rd, 2011
What Is the Impact of Screening Low-Risk Patients with CT Angiography?
Larry Husten, PHD
In a study published online in Archives of Internal Medicine, John McEvoy and colleagues examine the impact of screening low-risk patients with coronary CT angiography (CCTA). They compared 1000 South Korean patients who underwent CCTA with 1000 matched controls. CCTA identified 215 people with coronary atherosclerosis. At 90 days and at 18 months, statins and aspirin […]
May 18th, 2011
New Technique Cuts Radiation Dose of MPI SPECT by Half
Larry Husten, PHD
A new study raises the possibility that the radiation dose for MPI SPECT imaging can be reduced by half without sacrificing image quality, according to Dr. Nili Zafrir, who presented the results of the study this week at the International Conference of Non-Invasive Cardiovascular Imaging in Amsterdam. Recently, software has become available that can reduce the […]
May 18th, 2011
The Curse of the Mummy: Coronary Artery Disease?
Larry Husten, PHD
Could the real curse of the mummy be coronary artery disease? Despite strict adherence to the original Mediterranean diet and a complete lack of tobacco, trans fats, and refined sugars, an Egyptian princess who died around 1550 BC is the first person in history to receive a diagnosis of coronary artery disease. A CT scan of […]
January 19th, 2011
What PROSPECT Doesn’t Tell Us
Richard A. Lange, MD, MBA and L. David Hillis, MD
The PROSPECT trial provides some interesting insights about the mechanisms of thrombotic coronary artery disease, but how, if at all, should it change practice? Here are what the findings do and do not demonstrate: What the PROSPECT study says: In ACS patients treated with PCI, major adverse cardiovascular events that occurred during a median follow-up of 3.4 years were as […]
January 10th, 2011
Have the COURAGE to Critique a Substudy
Harlan M. Krumholz, MD, SM
In this journal club, I compare the published data from an original trial with the authors’ conclusions in a substudy from that trial. Often, a substudy provides valuable insights that complement the initial trial findings. Sometimes, however, you need to look closely to identify the additional insight. Case in point: COURAGE. The Original COURAGE Trial As reported […]
December 13th, 2010
False-Positive CT Angiogram Leads to Heart Transplant
Larry Husten, PHD
A 52-year old woman with atypical chest pain ended up with a heart transplant after a CT angiogram to “reassure” her sparked a devastating sequence of events. Following a false-positive CT angiogram, the patient underwent coronary angiography and suffered a dissection of the left main coronary artery, followed by emergency CABG, subsequent graft failure, and […]
October 28th, 2010
Drs. Clueless and Apathetic: The State of Imaging Referrals
Shanti Bansal, MD
Editors’ Note: This text has been modified from its original form. Key elements of the case represent a composite of people and events. On a bright Saturday morning, I was the fellow on duty in the chest pain center. That meant I was responsible for evaluating and stress-testing patients who had been admitted from the ER […]
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