Discover and read the best of Twitter Threads about #yesCCT

Most recents (24)

Thank u @Heart_SCCT @jolson106

Was an honor serving on #ASM committee #SCCT2022 & congrats @ghoshhajra for leading this team

My takeaways:
1) #ISCHEMIA captured current landscape of functional testing & put anatomy vs ischemia discussions in the center

ahajournals.org/doi/10.1161/CI…
2) We learned from those excluded from the trial as much as we did from those included #CIAO-ISCHEMIA

#SCCT2022

ahajournals.org/doi/10.1161/CI…
3) #DISCHARGE trial will make way for cathlabs to focus on complex procedures as #YesCCT assumes most diagnostic evaluations

nejm.org/doi/full/10.10…

#SCCT2022 @NEJM
Read 9 tweets
Dr. Karen Stout - presenting the 7 rules to evaluate #Congenital #HeartDisease by #yesCCT at #SCCT2022

Rule - 1: ALWAYS be prepared. Check cases a day prior & PLAN the imaging

@Heart_SCCT @FiRSTSCCT @SinghVasvi @AChoiHeart
KNOW the anatomy.
If you don’t understand the repair- LOOK up. #Google

@Fentanes_MD @JWeirMcCall @Nidhi_Madan9
Rule - KNOW the surgical history
#SCCT2022

@Heart_SCCT @SandeepHedgire @JWeirMcCall
Read 9 tweets
The DISCHARGE trial in online on the NEJM and it confirms what we all experience every day using CCT in a proper manner. CCT is safer, reliable and allows better management of stable patients with suspected obstructive CAD as compared to invasive strategy.
The main observation that comes to my mind however is still the very low prevalence of patients with obstructive CAD (25%) in both arms (CT and ICA). This is well known from previous studies and it is related to the selection criteria adopted for referral, partly.
The fact that still we send for an invasive and costly examination (CAG/ICA) this huge number of patients is simply astonishing in 2022. Healthcare cannot be managed like this, especially in universal systems like Italy, Germany, UK, Canada,...
Read 13 tweets
#JACCCardioOnc #Tweetorial: Along the spectrum of cancer Tx, #YeSCCT has a lot to offer regarding identifying subclinical #ASCVD, excluding obstructive #cvCAD in cardiotoxicity when appropriate. #CardioOnc, as a field, can gain from incorporating CCT in practice.

🧵1/
#YeSCCT may identify subclinical #ASCVD in cancer patients & survivors. Reviewing previous non-gated thoracic CT scans for CAC may help identify subclinical #cvCAD and start prompt preventive Tx.

#JACCCardioOnc #CardioOnc #MedTwitter #CardioTwitter

2/
Several clinical scenarios in the context of cardiotoxicity may require ruling out obstructive #cvCAD. Cancer pts tend to have ⬆️ risk of complications from invasive procedures➡️ thrombocytopenia & hypercoagulable states. #YeSCCT may derive significant benefit. #JACCCardioOnc

3/ This table shows some possible clinical indications of #YeSC
Read 5 tweets
The NEW @AHAScience @ACCinTouch @ASE360 @accpchest @SAEMonline @Heart_SCCT @SCMRorg Guideline for the Evaluation and Diagnosis of Chest Pain has been released. #CPguideline

jacc.org/doi/10.1016/j.…

Here are highlights for #YesCCT: (1/17)
(2/17) #CCTA receives the highest level of recommendation (1A) in new US #CPGuideline

Guideline sponsored by: @AHAScience @ACCinTouch @ASE360 @accpchest @SAEMonline @Heart_SCCT @SCMRorg

In this CP Guideline Tweetorial the (Level of Recommendation is in parentheses).
(3/17) Acute CP | Intermediate Risk & ⛔known CAD: After ruling out ACS, CCTA is useful to exclude plaque & obstructive CAD as a first line approach (1A) ✅ #CPguideline
Read 17 tweets
#SCCT2021 "Chance Favors the Prepared: Exam Prep & Safety" #YesCCT All in due process by Dr. Quynh Truong @cardioQT @WeillCornell
🧵
#SCCT2021 #YesCCT
1) QA/QI is a team effort: rads, cards, physicist, technologist
- quality control of equipment
- image acquisition: radiation ALARA, "right protocol, right dose - right patient"
- image interpretation: inter-reader agreement, correlation to cor angio/surg/path
#SCCT2021 #YesCCT
2) QC of🍩scanner:
model specs, test reports, maintenance logs, radiation exposure
Read 4 tweets
#SCCT2021 "Chance Favors the Prepared: Exam Prep & Safety" #YesCCT We need to talk by Dr. Jill Jacobs @nyulangone
🧵:
#SCCT2021 #YesCCT
1) Information Transfer & Direct Lines of Communication are 🗝️🔑
#SCCT2021 #YesCCT
2) Info for 👩‍🔬👩‍⚕️👨‍🔬👨‍⚕️:
- having dedicated info page useful/helps
- tips on maneuvering preauthorization
- where to direct ?'s
- contact info
Read 9 tweets
#SCCT2021 "Chance Favors the Prepared: Exam Prep & Safety" #YesCCT Why you gotta be so complicated? by Dr. Christopher Maroules @ChrisMaroules
🧵:
#SCCT2021 #YesCCT
1) Always consider the risk:benefit ratio
#SCCT2021 #YesCCT
2) Anticipating and managing adverse rxns to medications
Read 5 tweets
#SCCT2021 "Chance Favors the Prepared: Exam Prep & Safety" #YesCCT Rad to the 🦴(🫁 🫀) by Dr. Andrew Einstein @AndrewEinstein7 @CU_Cardiology
🧵:
#SCCT2021 #YesCCT
1) Dosimetry
☢️effects: Deterministic & Stochastic
Deterministic (AKA tissue reactions): rad-induced cell☠️, practical threshold dose, severity ⬆️w/ dose
Stochastic: rad-induced mutations, risk proport to dose (@ low doses), typical effects in DX imaging
#SCCT2021 #YesCCT
2) Dose
- Absorbed: average E imparted to matter vol by ionizing☢️/ mass of matter in vol
- wR:🧬effect of given absorb. dose based on type/quality of☢️emitted
- Equivalent = Absorbed✖️wR
- wT: prob of stochastic effects of equiv. dose based on tissue irradiatd
Read 6 tweets
#YesCCT : Clinical reporting & understanding finance by @docjuanb at #SCCT2021 . There are reimbursement challenges . #Cardiac CT is in the wrong Ambulatory Payment Classification (APC). Bill also must be supported by clinical symptom & diagnostic ICD10 codes. Not a “rule out”. ImageImageImageImage
Reimbursement tracks with the CPT used so use the right CPT code and make sure language in report supports that code. All CTA assumes 3D, thus need to mention 3D in report. Have your reporting align with @Heart_SCCT guidelines. @docjuanb at #SCCT2021 ImageImageImage
Unfortunately #cardiacCT often lumped into CT not cardiac. Hospitals should update cost charges to accurately reflect true cost of work, align w/ other cardiac testing. With costs underreported, CMS bases APC & reimbursement on these historically lower costs @docjuanb #SCCT2021 ImageImageImage
Read 4 tweets
Lessons learned in training your #yesCCT team by @appropriateuse #SCCT2021 : Step 1: Learn the current set-up. ImageImageImageImage
Lessons learned in training your #yesCCT team by @appropriateuse #SCCT2021 : Step 2: Expand the service. Step 3: Educating the team. ImageImageImageImage
Lessons learned in training your #yesCCT team by @appropriateuse #SCCT2021 : Step 4: Quality Assurance; Step 5: feedback; step 6: Management ImageImageImageImage
Read 4 tweets
Will #AI enhance care of patients?
Yes!
How?
-Improved reliability
-Atherosclerosis guided Rx
-Risk prediction
-Requires validation ✅

Proud to share my #SCCT2021 talk (1/5)
AI & ML in #YesCCT: New Frontiers in Atherosclerosis
@mirvatalasnag @HeartOTXHeartMD @DrIanWeissman
#SCCT2021 (2/5)
AI & ML in #YesCCT: New Frontiers in Atherosclerosis

-The field of #YesCCT has evolved rapidly
-Current CV risk prediction models are inadequate – can AI help?
-Average imager may read > 1 billion pixels per day
#SCCT2021 (3/5)
#AI & ML in #YesCCT: Atherosclerosis

-Be mindful of caveats, ensure validity & avoid hype
-Opportunity to improve #CCT reproducibility (in conjunction w/ education!)
-#CLARIFY - algorithm validation
-#CLARIFY– high accuracy for %stenosis

@mirvatalasnag
Read 5 tweets
Great session on Artificial Intelligence and Machine learning with session chairs @imagingmedsci, Dr. Bratt, @michael_t_lu, @ivanaisgum, Dr. Al'Aref and @DeCeccoCN at #SCCT2021!

#ICYMI - Here's a brief tweetorial from the #YesCCT session (1/7)
@mirvatalasnag @HeartOTXHeartMD
#AI & ML in #YesCCT: #SCCT2021 #Tweetorial (2/7)
1⃣: The big picture & black box by Dr. Michael Lu
-Multiple “black box” definitions
-Explainability
-Predictability
-More accurate than SOC, visualizes output (& modifiable), communicates uncertainty (eg grey-zone FFR-CT)
3⃣#AI & ML in #YesCCT #SCCT2021: New frontiers in atherosclerosis @AChoiHeart

-Use of #CNN for whole heart stenosis & atherosclerosis
-Improved reproducibility of stenosis to enhance guideline adherence
-Individualized risk prediction
-New Rx paradigm!
Read 7 tweets
Women are not smaller men! #Atherosclerosis genesis, progression & sequelae different in women. Plaque erosion causing ACS more common in women. Women have unique #SDOH, are undertreated with #cvPrev therapies & #GDMT, leads to worsening outcomes in women. @lesleejshaw #SCCT2021 ImageImageImage
Women’s CVD risk can be underestimated. Female specific risk enhancers help. #CAC if risk uncertain. Women have lower #CAC prevalence than men but prevalence increases after menopause. CAC when present confers greater risk of incident CVD in women than men. @lesleejshaw #SCCT2021 ImageImageImage
Prevalence of non-obstructive #CAD is higher in women but is prognostic of risk. @lesleejshaw #SCCT2021 ImageImageImage
Read 6 tweets
Top 10 paper in #yesCCT by @ToddVillinesMD

1st paper

📝 Italian COVID 19 registry
N=1625
📝 Increasing #CAC associated with worse covid 19 outcomes of hospital death, MI and CVA
#YesCCT
2nd paper #Top10 papers #yesCCT
#SCCT2021
danish heart registry
📝 Plaque burden, not stenosis the main predictor of MACE
📝 patients with a comparable calcified atherosclerosis burden generally carry a similar risk for CVD events
jacc.org/doi/abs/10.101…
3rd paper #Top10 papers #yesCCT
#SCCT2021

CREDENCE trial
📝 Stress MPI vs #yesCCT for diagnosis of coronary physiology
📝 #yesCCT superior to stress MPI in the diagnosis of invasive FFR
jamanetwork.com/journals/jamac…

@lesleejshaw @RonBlankstein @AChoiHeart @ghoshhajra
Read 10 tweets
🚨How do you get a STEMI without atherosclerotic coronary artery disease?? 📟

✏️ Drawing a blank? 📃

Join me to learn more about the world of non-atherosclerotic coronary artery disease and coronary artery vasculitis!
🎣 In this tweetorial, we'll tackle how to -

🚨 Implement an approach to ⬆️ troponin

🚨 Classify non-atherosclerotic coronary artery disease

🚨 Recognize causes of coronary artery vasculitis
So, how do you feel answering the following question:

"I feel comfortable identifying a patient with coronary artery vasculitis."
Read 23 tweets
What is the most commonly performed imaging test for CAD in the U.K.?
The most common imaging test is #CVnuc, #yesCCT increasing after 2016 NICE CG95 but the treadmill is still the most common test whatever the guidelines say openheart.bmj.com/content/6/2/e0… Image
Myocardial perfusion #scintigraphy for the diagnosis and management of CAD was first assessed by NICE in 2003 nice.org.uk/guidance/ta73
Read 14 tweets
Tweetorial on Challenges in Quantification of Aortic stenosis before tonight’s #ASEchoJC on @PPibarot & @E_Guzzetti 📝 bit.ly/2NNIJgC

~1/3 pts have DISCORDANT indices: AVA is severe <1 cm2 yet mean gradient is low <40 mmHG bit.ly/3dWmJuy

Low Gradient types👇
2/low gradient severe AS
types:

1.Classic:both flow SVI EF⬇️(classical Low flow CLF)

2. Paradoxical: EF nl BUT low flow SVI (Paradoxical Low flow PLF )

3. Both EF and flow are nl (Normal Flow NF)

Low flow⬆️💀mortality
Paradoxical Low flow &
Classical Low flow #ASEchoJC
3/ low gradient represents more advanced cardiac disease stage
D2: classical low flow low EF low gradient
D3: paradoxical low flow nl EF low gradient
D? normal flow nl EF low gradient
#ASEchoJC
Read 10 tweets
📝 Major Clinical Trials for the Management of Stable CHD in the Past 2 Decades

📌COURAGE (2007)
📌BARI-2D ( 2009)
📌STICH (2011)
📌FAME-2 (2012)
📌FREEDOM (2012)
📌ORBITA (2018)
📌ISCHEMIA (2020)
@mmamas1973 @mirvatalasnag @ErinMichos @DavidLBrownMD @DLBHATTMD @iamritu
*COURAGE* (n = 2,287)
PCI + OMT vs. OMT in stable CHD
• All had evidence of ischemia
• 31% triple-vessel CHD
• 4.6 years median follow-up
• HR death/MI 1.05 (95% CI: 0.87 to 1.27
Read 10 tweets
Brilliant presentation by Dr. @PPibarot on Aortic Valve Calcium Score @MonteHeart CT/CMR Lecture on 10/16/20.
💥Important to begin by appreciating burden of AS.
💥#echofirst remains primary modality to assess HEMODYNAMIC severity.
💥Need other tools to assess ANATOMIC severity!
💥JACC 2019➡️Review non-contrast CT to measure AVC in AS.
💥An example protocol by Dr. @PPibarot ⬇️ measuring calcium burden in en-face view of AV.
💥Pitfalls: inclusion of LVOT, sorta, mitral annulus & cors. Multi-planar reconstruction helps carefully exclude non-AV calcium.
💥Women & Men are different! For a given amount of AVC, 🚺 have a ⬆️ peak jet vel. by #echofirst. For a given peak vel. by #echofirst 🚹 have higher iAVC.
💥AVCd didn’t help resolve the discordance.
💥2017 ESC guidelines for severe AVC ➡️>1200 AU 🚺,>2000AU🚹.
Read 10 tweets
#Tweetorial on #ASNC2020 session

⚡Selecting Between Different Functional Tests⚡

☢ vs 🧲 vs ⏺ ❓

🔘 Strengths/Limits of Lesion Specific vs Myocardial Ischemia
🔘 Comparing Dx Accuracy of Tests
🔘 Ischemia Testing in #INOCA
🔘 How to Select Best Noninvasive Test

1/9
#ASNC2020 #cvNuc
2/9
Dr Di Carli

☢ Issues with proposed #FFR threshold 0.8
☢ Exercise MPI correlates well with FFR but not at 0.8
☢ Benefit of FFR-guided revasc dominantly occurs w/ thresholds <0.8
☢ Quantification of lesion-specific #ischemia insufficient for patient mgmt
#ASNC2020 #cvNuc
3/9
Dr Di Carli

Lesion-specific #ischemia measurements (FFR/#FFRCT)

☢ Strength
Validated against ETT/MPI
Strong outcome data
Guidelines supported

☢ Limit
Controversial threshold (0.80 vs MPI-validated 0.66)
⬆ microvasc resist causes FFR pseudonormalization
Read 11 tweets

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