🌈 Spectral data paves the way for plaque phenotyping, perfusion mapping, myocardial characterization - a possible "one-stop" exam?

🤔 Still need: larger prospective clinical validation and cost-effectiveness data

📖 www.jacc.org/doi/10.1016/...

@ArthurShiyovich @RonBlankstein #cardioSky #CCTA

💥 Just out in #JACC CVI: State-of-the-Art on Photon-Counting CT

👇 Why this technology is a game-changer:
☢️ Better for patients: ⬇️ radiation and ⬇️ contrast
😅 Better for readers: spatial rez of 0.1mm + ⬇️ blooming = stents and calcified plaques are clearer than ever before

✨ Beautiful #CMR pictures. Young patient with new chest pain. SSFP, T2W, and LGE.

#NorthwellHealth #cardiosky

🪦 Ischemic heart disease remains the #1 cause of death worldwide

💥 That's 8.9M premature deaths or 136M years of life lost in 2023 alone

💊 We need a better strategy to detect and prevent ischemic heart disease

👏 Thanks to GBD for another incredible report: www.thelancet.com/journals/lan...

#CCTA

👉 Key strategies include: prospective gating, reduced field of view, BMI-tailored kVp, elimination of redundant phases, and hands-on training for techs.

🔬 Here, Chazal et al describe how a multicenter CCTA program used these strategies to lower mean radiation dose by 23%! doi.org/10.1016/j.ja...

💥 As coronary CTA volumes increase, we must keep radiation exposures as low as reasonably achievable.

☢️ AHA/ACC/SCCT recommend a goal of median CCTA dose ≤4 mSv, which has been achieved in multicenter trials without compromising quality.

❗ Impressively, only 1% of scans were indeterminate, and there was good diagnostic performance regardless of stent diameter.

@DoosupShin @ziadalinyc @OKhaliqueMD #cardiotwitter #CCTA

eurointervention.pcronline.com/article/phot...

💥 Photon-counting detector CT offers good diagnostic accuracy for detecting ISR, overcoming artifacts that have plagued prior generations of scanners.

🔬 In a blinded study of 283 stented lesions, PCD-CT, as compared to cath, demonstrated NPV of 96.4% and accuracy of 88.9% for ISR ≥50%.

🧲 #CMR can identify cardiac allograft vasculopathy effectively and non-invasively.

🔬 In this study of 110 patients s/p heart transplant, quant myocardial perfusion reserve <2.2 had NPV 100% and AUC 0.88 for significant CAV, as compared to cath. doi.org/10.1093/ehjc...

@SCMR @EHJ #CardioSky

💫 #CMR is useful for predicting SCD in NICM.

📊 DERIVATE 2.0 provides better risk classification, incorporating gender, LVEF, and amount/location of #LGE.

👉 Let's look beyond LVEF alone to determine which NICM patients get ICD.

Full text: doi.org/10.1093/ehjc...
#CMR @SCMR #cardiosky

⭐ What this means:
--Traditional screening tools miss many at-risk people
--Even when risks are recognized, preventive therapies often aren't started
--We need a better strategy to identify disease earlier

@DLBHATTMD #cardiotwitter #CAD #CCTA @SCCT
doi.org/10.1093/eurh...

🚨 Preventing first heart attacks may need a rethink.

🔬 In this massive study of 4.6 million people with their first heart attack:
--18% had no standard modifiable risk factors
--51% had no warning symptoms beforehand
--63% weren't on preventive meds (only 22% on statin)

💊 If positive, guidelines could rec #CCTA for asymptomatic adults, allowing us to detect and treat #CAD earlier to prevent more heart attacks.

🫀 To prepare, we need to model what a positive trial could mean for patient volumes and what it would take to meet that need.

🏴󠁧󠁢󠁳󠁣󠁴󠁿 #cardiosky

💥 The SCOT-HEART 2 trail could transform how we identify those at risk of heart attacks.

🔬 Trial randomizes asymptomatic patients ages 40-70 with ≥1 risk factors to either #CoronaryCTA or standard care, with appropriate therapies, looking for primary outcome of heart attack.

Superb article summarizing the knowns and unknowns of broken heart syndrome (Takotsubo syndrome).💔

Yes, emotions can stun the heart. A fascinating tale of mind–heart biology. Full text here: www.nature.com/articles/s41...

@elmir1omerovic #cardiotwitter

🚨Late-presenting ostial LAD STEMI, imaged 7-days later with #CMR. Here's the #LGE.
❓Would you call thrombus? Microvascular obstruction? Intramyocardial hemorrhage? Or a combination of these?
@NorthwellHealth @LenoxHill #cardiotwitter

❓As Plaque Analysis roles out nationwide for #CCTA, providers are asking "How will this change clinical management?"
✔️The DECIDE registry provides one framework: Total Plaque Volume determines level of therapy.
🔬More research is needed to show impact on hard outcomes.
#cardiotwitter @NorthwellHealth

This #CMR shows anteroapical intramyocardial enhancement.
Taking the image as a whole, what's one potential explanation?
#cardiotwitter #CardiacImaging

Important multicenter study in #EHJ
#CMR outperforms societal recs for ICD placement in cardiac sarcoidosis
📈AUC=0.86 for 5-yr risk of fatal/life-threatening arrhythmias
⚡Highest risk = abnl LVEF + LGE that is multifocal, septal, subepicardial, or involves RV freewall
buff.ly/Nc2upbU
#cardiotwitter

Nice review in #EHJ on LGE and SCD by @DrMarchlinski et al. buff.ly/GeU589P
🫀Good reminder that in CAD: LGE predicts SCD better than LVEF; absence of LGE has a high NPV for SCD
🔭Looking ahead, digital twins made from CMR data undergo virtual inductions to uncover arrhythmia risk
#cardiotwitter