Cardiac care technology is advancing at an impressive rate. It seems like every month brings a new imaging technique, treatment option, or research finding with a lasting impact on how cardiac care is delivered or managed.
Cardiology imaging specialists have a unique role to play in the continued development of cardiac care. Innovations in technology require experienced, knowledgeable experts who can discern if, when, and how the new technology can be used to improve patient outcomes.
This month’s cardiology imaging roundup features two articles about breakthroughs in treatment, and two that ponder the implications of ever-evolving technology.
73-year-old Doug Taylor made history last month as he became the first to be implanted with a new type of heart stent. The stent is biodegradable, intended to be fully reabsorbed into the body two to three years after implantation.
The stent was designed to avoid some of the issues associated with drug-coated metal stents, which can lead to long blood-thinning regimens to avoid the risk of clots. The presence of a metal stent can complicate the diagnosis of further issues as well, leading to a 2-3% occurrence of heart attacks or other serious problems related to the treated artery.
Though the device has received USFDA approval, its potential long-term benefits have not yet been proven. Imaging will play an important role in patient outcomes; sophisticated imaging equipment and procedures will be necessary to ensure the device is properly implanted.
A new technique for subtraction coronary CT angiography (CCTA) appears to allow for scans with and without contrast in under 15 seconds. Conventional subtraction CCTA can require breath-holds of 20-40 seconds, which can be difficult to impossible for some patients.
The technique reverses the order of the scans, with the post-contrast scan first and the mask scan second. This not only cuts breath-hold time, it appears to increase the average image quality as well.
The researchers say this first trial was a small one, to gain experience and demonstrate the procedure’s feasibility. They plan to enlarge their sample set and compare their results to invasive coronary angiography.
Will advances in non-invasive cardiac imaging actually translate to improved patient care? The new modalities certainly can improve the accuracy of assessment, but some cardiologists are skeptical about their real-world implementations.
The chief concern is some of the new tests may not actually make an impact on treatment decisions. According to Professor Tom Marwick, CEO of Baker IDI Heart and Diabetes Institute, “If we do a more accurate and more sophisticated test but it doesn’t make any difference to the decision making, then that’s not money well spent. If we repeat simple tests, like ECGs or stress tests, and it doesn’t translate into improved decision making, that’s not money well spent either.”
The full article at MJA Insight rounds up a panel of doctors to give their opinions on newer test modalities and whether or not they have proven to provide value.
High-sensitivity cardiac troponin (hs-cTn) tests may usher in a change in the role of imaging in cardiac treatment. A new strategy in hs-cTn testing can rule out acute myocardial infarction in one hour, with 75% accuracy.
Some cardiologists believe these cardiac biomarker tests can reduce the need for noninvasive imaging. If the hs-cTn levels are below the 99th percentile or undetectable, additional testing could lead to false-positive results.
This article speculates the role of noninvasive cardiac imaging in the ED will shift to the role of “gatekeeper to aggressive therapy,” helping to zero in on a diagnosis when hs-cTn levels are mildly abnormal, thus not immediately suggestive of AMI.
Each new advance in technology presents challenges for cardiology imaging specialists. As treatments change and roles shift, imaging specialists must keep their knowledge base current and be prepared to intelligently evaluate new technology and its implications.