Dr Bateman on now! On to why Ischemia testing wins.
He takes us back to 1980s, the first of the scanners!
He debates that the ischemia is about MYOCARDIUM and not just about the epicardial coronary artery
He also talks about populations most affects, older patients with many comorbid conditions. A population not really an ideal one for CTA with more kidney disease, more calcium!
He talks about PROMISE that did not show any change in the primary endpoint.
Diagnosis substantially improved with PET comapred to SPECT or even CTA. You also get MBFR with PET and it predicts outcome regardless of levels of ischemia.
And there is an interaction between ischemia and MBFR. @TimBateman6 !
He also debates that PET gives better idea of who may improve symptoms. It also gives a lot of other information! Myocardial blood flow, calcium score, risk prediction, ischemia etc.
Example of a patient who has very low MBFR which also provides a very good negative predictive value! @venkmurthy
@MyASNC #ASNC2020 #CVNuc .
He concludes by suggesting ischemia testing WITH CAC is the first line for stable chest pain! He also tells us where CCTA may be appropriate!
But for majority of the patients a comprehensive assessment of function is needed and hence the role for CTA is smaller and myocardial perfusion imaging is the clear winner!
That is it from Dr Bateman!
Now Dr Newby is back for the debate. He debates that the ischemia testing is just a surrogate and not looking at the actual DISEASE!
He points out that even with a normal perfusion imaging, patient still MAY have CAD. And therefore it is not the best of the tools to DIAGNOSE CAD. For preventing a heart attack ischemia testing is going to miss half of them and therefore we need to move onto CT!
Dr Bateman now! He suggests why nuclear will remain first line for stable chest pain. Any test needs to diagnose subclinical disease and therefore CAC in addition to nuclear is important. Also needs to look at advanced markers with perfusion imaging and not just the defects.
With microvascular dysfunction increasing, patients may need ICA first anyway so there may really be no role for CCTA, Dr Bateman continues.
He discusses four essential disease states- these can be clearly sorted out by PET!
CTA does not sort out among these and with CTA you really dont know what you are MISSING.
Therefore PET remains the test of choice and CCTA has to overcome many challenges and wont replace MPI as the test of choice!
Those were our debates. Thank you for joining in!
@ShadenKhalaf
@RBP0612
@cardioimage
@krishnapatel888
@SinghVasvi
@nappicarmela
@Ggrossman11
@SanjayDivakaran
@RezaEmaminia
@CoronaryDoc
@sarahcud
@CesiaGallegos
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