Aditya A Joshi Profile picture
Sep 26, 2020 22 tweets 12 min read Read on X
Dr Bateman on now! On to why Ischemia testing wins. Image
He takes us back to 1980s, the first of the scanners! Image
He debates that the ischemia is about MYOCARDIUM and not just about the epicardial coronary artery ImageImage
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! Image
He talks about PROMISE that did not show any change in the primary endpoint. Image
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. ImageImage
And there is an interaction between ischemia and MBFR. @TimBateman6 ! Image
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. ImageImageImage
Example of a patient who has very low MBFR which also provides a very good negative predictive value! @venkmurthy ImageImage
@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! Image
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! ImageImage
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. Image
With microvascular dysfunction increasing, patients may need ICA first anyway so there may really be no role for CCTA, Dr Bateman continues. Image
He discusses four essential disease states- these can be clearly sorted out by PET! Image
CTA does not sort out among these and with CTA you really dont know what you are MISSING. Image
Therefore PET remains the test of choice and CCTA has to overcome many challenges and wont replace MPI as the test of choice! ImageImage
Those were our debates. Thank you for joining in!

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More from @AdvancedHFBuddy

Sep 26, 2020
Now the second debate! Dr Newby on debating that CT is the first line in stable chest pain!
He starts by disclosures and states what the patient may care about and that is what he will talk about. ImageImage
He debates that his opponent has published a paper suggesting specificity for CT is almost >90% ImageImage
Read 12 tweets
Sep 26, 2020
This is Dr Miller now! #ASNC2020 @MyASNC #CVNuc
Statin wins!
No benefit from stents in outcomes! Image
Old trials have suggested no benefit in symptoms over time as well. Same with ischemia showing no benefit in composite endpoint or in symptoms.
He questions a 2 point change in SAQ summary score seen in ISCHEMIA. What does it exactly mean in clinical world? ImageImage
Read 24 tweets
Sep 26, 2020
The first debate between Dr Johnson and Dr Miller! Dr Johnson presents a case to begin the talk. ImageImage
Here is the cath and the FFR! Image
SKepticism for PCI from both physicians and the guidelines committee. Image
Read 12 tweets
Sep 26, 2020
@krishnapatel888 presenting the case before we start the debate. @MyASNC #ASNC2020 #CVNuc ImageImageImageImage
Images and MBFR presented ! Pay attention to LAD and LCX territories. Image
And THE QUESTION! Image
Read 11 tweets
Sep 17, 2020
Now on is Dr. Eshtehardi @CoronaryDoc talking about "Going Live: Tweets, Tweetorials and Twitter Polls" Last talk in the session. ImageImage
Great point: Structure of a simple tweet has many intricate parts! Text, hashtags, people tagged in the text AND photos, links and replies!
You can determine who can reply to the tweets. Image
Tweetorials are an important part of #MedTwitter #cardiotwitter education.
We also have a repository of up to 2000 tweetorials now! Image
Read 16 tweets
Sep 17, 2020
Next up @RBP0612 talking about "Maximizing your conference presence using your Social Media" Image
#ASNC2019 had close to 20 million impressions! Image
Global reach of conferences using #SoMe is impressive Image
Read 17 tweets

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