Chẩn đoán Hình ảnh Tim mạch có gì mới trong năm 2015-2016

Cardiovascular Imaging 2015-16Focused Cardiac Ultrasound Cardiac CT Perfusion Therapeutic Ultrasound CAC - 15 year prediction High Risk Plaque THE 15 ra NATIONAL CONGRESS OF CARDIOLOGY

Year-in-Review

Imaging:

2015-2016

Adj Ass Prof Ong Hean Yee

Senior Consultant and Head of Department

Department of Cardiology

Khoo Teck Puat Hospital

THE 15 ra NATIONAL CONGRESS

OF CARDIOLOGY 2 0 16

Astra Zeneca, Bayer

All Honorariums donated to Department Research and Training Fund

THE 15 ra NATIONAL CONGRESS

OF CARDIOLOGY 2 0 16

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Cardiovascular Imaging 2015-16

Focused Cardiac Ultrasound

Cardiac CT Perfusion

Therapeutic Ultrasound

CAC - 15 year prediction

High Risk Plaque THE 15 ra NATIONAL CONGRESS

OF CARDIOLOGY 2 0 16

Cardiovascular Imaging 2015-16

Focused Cardiac Ultrasound

Cardiac CT Perfusion

Therapeutic Ultrasound

CAC - 15 year prediction

OF CARDIOLOGY 2 0 16

International Evidence-Based Aecom mendations

Ultrasound

G a bri e le V , MD , Arif Hu ssa in ,

R o e r t R ea r do n , MD , M a hm o d

Al ek s nd a r N Nes k ov i c , MD , PhD ,

MD , Mi ke We ll s , MD , BSc , B Sc H o s, MB BCh , FCE M , Dip P EC,

E l Bar b a r y, MD , V i c ki E Nob le MD , I a rn e s W T s u g , MD , MP H ,

FESC , F A CC , S u s nn a Pri ce, MD , MBB S , B Sc , MR CP , E DI CM , PhD ,

F I C M , FE S C, A c hi ka m Or e n - Gri n e r g , MD , M S , Andr ew Li te pl o , MD , RDM S , Ri ca r do Co rdi o l , MD ,

N ith a Na q i, MD , MSc , MR C P C H P hilipp e R o l a , MD , Ja n Poelae rt , MD , PhD , Tat j ana G o l o b Gu l c, M D ,

E rik S l oth , MD , PhD , DMS c , Arthur L a b v it z, MD , FA CC, Bru ce Kimur a, MD , F ACC , R ao u Br e itkr e ut z , M D , N a v r oz Masani , MBBS , FR C P , Ju s tin Bo w r a , FA C EM , CC PU ,

D a ni el Talm o r , MD , MPH ,

F a bi o Guarrac i n o, MD , Adri a n G o udi e , BM e dS c i ( H o s ) , MBBS , FA CE M DD U Wa n g Xiao tin g, MD ,

Ra jes h C h aw l a , MD , FCC M , M a uri z i o G a ld e ri s i , MD , Mi c h eal B la i v as , MD , FACE P , F AI U M ,

To mi sl av P e tr ov i c , MD , E nri co Sto rti , MD , L u ca Ne r i , M D a n d Law ren ce M elnik e r , M D M S , Intern a ti o al L i ai s o n C o mmi tt e e o n Foc u s d C a rdi a c

U l r aSo und ( L C - Fo CU S ) fo r th e Int e rn a ti o a l C o fe r e n ce o n F o c u s ed Ca rdi ac Ul tr aSo und ( C - Fo C US )

J Am Soc Echocardiogr 2014; 27: 683, e1-e33

Focused Cardiac Ultrasound

A&E ICU

J Am Soc Echocardiogr 2014; 27: 683, e1-e33

THE 1 5 ™ NATIONAL CONGRESS

OF CARDIOLOGY 2 01 6

Focused Cardiac Ultrasound

Aorta Dilation and Aneurysm

P e im a n Nazer i a , MD , S i m o e Va nni , M D , PhD , Fu l vio More ll o , M D , PhD , M atteo Cas t elli , MD ,

Acac Emerg Med 2015; 22: 536–541

THE 15 rn NATIONAL CONGRESS

Focused Cardiac Ultrasound

Nazerian et alAcad Emerg Med2015; 22: 536

Ascending Aorta measurement in A+E vs CT

Jones AE et alShock

2005; 24: 513-7

Hypotension due to Cardiac Dysfunction vs Hypovelemia

Yim ES et al

J Ultrasound Med2013; 32: 333-8

Screening for HCM in Sports Clinic

Fedson SJASE2003;16:901-5

Use of hand held echo machine in underpriviledged

community

Spencer KT

JACC2001;37:2013-8Clinical Examination versus handheld machine

THE 15 ra NATIONAL CONGRESS

OF CARDIOLOGY 2 0 16

Focused Cardiac Ultrasound

A&E ICU

=

?

J Am Soc Echocardiogr 2014; 27: 683, e1-e33

THE 1 5 ™ NATIONAL CONGRESS

OF CARDIOLOGY 2 01 6

Focused Cardiac Ultrasound

Cardiovascular Imaging 2015-16

Focused Cardiac Ultrasound

Cardiac CT Perfusion

Therapeutic Ultrasound

CAC - 15 year prediction

OF CARDIOLOGY 2 0 16

Our Preoccupation With Coronary Luminology

The Dissociation

Heart Disease

E r i cJ T opo l , MD ; S t even E Ni sse n , MD

Topol Nissen Circulation 1995; 92: 2333-2342

OF CARDIOLOGY 2 0 16 ~·: : : .

THE 15 ™ NATIONAL CONGRESS

Functional vs Anatomy

Optim a l M e i c l her apy w it h or w ithout PC I

fo r Sta bl e Co ron ary Di sease William E Boden, M D , Robert A O ' Rourke, M.D , Koon K Teo, M.B., B.Ch., Ph.D , Pamela M Hartigan, Ph.D., Davidj Maron , D., Williamj Kostuk, M D , Merril Knudtson, M.D , Marcin Dada, M.D , Pau l Casperson , Ph.D ,

Crystal L Harris, Pharm.D., Bernard R Chaitman, M.D., Leslee Shaw , Ph.D., Gilbert Gosselin, M D., Shah Nawaz, M.D., Lawrence M Title, M.D., Gerald Gau, M D., Alvin S B l austein, M.D., David C Booth , M.D., Eric R Bates , M.D , John A Spertus, M.D , M.P.H , Daniel S Berman , M.D , G.B.John Mancin i , M.D ,

and William S Weintraub, M.D , for the COURAGE Tria l Research Group *

COURAGE NEJM March 2007 vol 356

Haza r d ratio ,

MEDICINE

Revascularisation by Anatomy

Revascularisation by Function

Functional Fractional Reserve

FFR 0.75 good correlation

with functional tests

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fo r Sta bl e Coronary Artery D isease

B ernar d D e B r u , M.D , P h D , W i ll iam F F earon, M D , N ico HJ Pijls, M.D., Ph D.,

Em a nu e l e B a rb ato, M D , Ph D , P i m T on i no, M D , Ph D , Z solt P iro t h, M D ,

N o la g ic , M D., Sven Mo biu s-Wi n ckle r , M D., G ill e s R io u fo l , M.D., Ph.D., N i s

Wi tt , D , P h D , P e tr la , M D , Philip M a cc a rthy, M D , Thomas Engs tr o m , M D , Ke ith Ol dr oy d , M D , Kre t o n Mav r o m atis, M.D.,

Ga ne sh M ano h ra n, M D , P e t e r V eri , M D , Ole Frobe rt , M D ,

N ick C urz e , B M , P h D ,Jane B Jo hn so n , R N , B S.N., A n dr eas Limache r , P h.D.,

Eve ln e Nu esch, P h.D., d Pe t e r ju n i, D , fo t h e FA M E 2 Tr ial I n ves t igato r s*

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1 Summarized MyocardialPerfusionProtocols TABLE

THE 15 ™ NATIONAL CONG RE S S

Sca nn e r requir emen t 64 - slice CT

Acq u is i t i on mode ECG - t ri gge r ed ax i a l scan mode

reso l ut i o datasets

5 - 10 mSv *

M yoca r d i a l b l ood flow

M yoc r d i a l b l ood vo l u me

CT perfusion

Dynamic CT myocardial perfusion measurements

of resting and hyperaemic blood flow in low-risk

subjects with 128-slice dual-source CT

Kheng-Thye Ho 1* , Hean-Yee Ong2, Grace Tan3, and Quek-Wei Yong 4

IV Dipyridamole 0.56mg/kg/min (4 min)

EHJ Cardiovascular Imaging 2015 Mar 16 (3): 300

CT perfusion

Dynamic CT myocardial perfusion measurements

of resting and hyperaemic blood flow in low-risk

subjects with 128-slice dual-source CT

Kheng-Thye Ho 1* , Hean-Yee Ong2, Grace Tan3, and Quek-Wei Yong 4

EHJ Cardiovascular Imaging 2015 Mar 16 (3): 300

CT perfusion

Dynamic CT myocardial perfusion measurements

of resting and hyperaemic blood flow in low-risk

subjects with 128-slice dual-source CT

Kheng-Thye Ho 1* , Hean-Yee Ong2, Grace Tan3, and Quek-Wei Yong 4

EHJ Cardiovascular Imaging 2015 Mar 16 (3): 300

CT perfusion

Cardiovascular Imaging 2015-16

Focused Cardiac Ultrasound

Cardiac CT Perfusion

Therapeutic Ultrasound

CAC - 15 year prediction

OF CARDIOLOGY 2 0 16

Diagnostic Ultrasound Impulses Improve

C ros s Mark

Microvascular Flow in Patients With STEMI

W il son Ma t h i a s , J R , MD ,3 Jeane M Tsu t s ui, M D ,3 Bruno G Tavares , MD ,3 Fen g Xie, MD, b M i gue l O D Agu i ar, M D

Di e o R Garci a, MD ,3 Muci o T O li v i ra J R, M D ,3 A l e andre S o i ro , MD ,3 J o se C Ni c olau , MD ,3

Pedro A Lemo s , N ETO , M D ,3 Car l os E Ro c itt e , M D ,3 J ose A.F R a m ire s, M D ,3 Rob e rto K a lil , F I LH O, MD ,3

T h oma s R Por t e r , MD b

1 Ultrasound Treatment Regimens

TABLE

H M I Pulse

Frequency/Pulse Durat i on

FR (Hz)

Number of Pulses per Line

Sector Size (0 )

Number of Lines pe r F r ame

Du r ation of Therapy Pre-PCI (min)

Diagnostic Ultrasound Impulses Improve

Microvascular Flow in Patients With STEMI

Receiving Intravenous Microbubbles

W il son Mat hi , JR, MD,3 J eane M T s ut s ui , M D ,3 Brun o G Tavares , MD , a n g X i e, MD, b M i gue l O D Aguiar ,

D i ego R Garcia, MD,3 M u cio T li veira, JR, M D ,3 A l exa ndr e Soe i ro, MD,3 J ose C Nico l au, MD,3

Pedro A L e m os, N ETO , M D ,3 Ca rl os E oc hitt e, MD ,3 J ose A F Ramir es, MD,3 R o rt o K a lil , FI LHO , M D

Cardiovascular Imaging 2015-16

Focused Cardiac Ultrasound

Cardiac CT Perfusion

Therapeutic Ultrasound

CAC - 15 year prediction

OF CARDIOLOGY 2 0 16

A 15-Year Warranty Period

Asymptomatic Individuals

for Without

A Prospective Follow-Up of 9,715 Individuals

J Am Coll Cardiol Img 2015; Aug 8 (8): 900-9.

J Am Coll Cardiol Img 2015; Aug 8 (8): 900-9.

I I I I

I I I

15 year warranty

Cardiovascular Imaging 2015-16

Focused Cardiac Ultrasound

Cardiac CT Perfusion

Therapeutic Ultrasound

CAC - 15 year prediction

OF CARDIOLOGY 2 0 16

Compu t ed tomog r aphy-based high- r isk coronary

patients

plaq u e score to predict acute coronary syndrome among with ac u te chest

pain - Results fr om the ROMICAT II t rial

P a l Mau r ov ich - H orvat

Plaque Characterizationby Coronary

Computed Tomography Angiography

and the Likelihoodof Acute Coronary

Events in Mid-Term Follow-Up

Sa d ak o M o t oy a ma , M D , 1 ill , •t H a j im e Ito , MD, Pl1 D , • Ma s ayo s hi r a i , MD , H , • ak e hi K o nd MD , HD , •

Hi d eki Kawa i , M D , H ,* Y a om i Na g aha r a, M D ,* ro t a ar i g aya , M D , Pll D t hin a a , M D t

Hi rofu m i A n o, M D , H , § Hi ro s hi T akaha s i , B S c , 1 1 royu ki Na ru s e, M D , PHD , * J i ch i I s hii , M D , P H , *

H arve y e t , M D , t es l ee J S h aw , HD , 41 Yuk i o O z ak i , M D PH D ,* J aga t N aru l a , MD , Pll D t

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ACC 2007

PR (Positive Remodelling) (Remodeling Index > 1.1) LAP (Low Attenutation Plague) (< 30 Hounsfield Unit)

Significant Stenosis (> 70% luminal stenosis)

THE 1 5 rn NATIONAL CONGRESSHigh Risk Plaques / Stenosis

TABLE 3 ACS Development per Plaque and Stenosis Characteristics

1,962) HRP( - / SS( + ) ( n =

542) HRP( + ) / SS( - ) ( n =

1 77 ) HRP( + ) / SS( + ) ( n =

dyslipidemia , BM I > 25 kg/ m 2 , and previous A C S.

steno s is ~70%; oth e r abbr e viations as in Tables 1 and 2

Motoyama et al J Am College Cardiol 2015; 66: 337-46

Sign* Adij ufsteidcfoar ange , tdysSlipidtemeia ,nBMoI >s25

ikgs/ m 2 ,Oandnprelvyious A C S.

HR HR

2.89 13.13

SS = signi fi cant steno s is ~70%; oth e r abbr e viations as in Tables 1 and 2

High Risk Plaque Only

CCT 2015; 9 OF CARDIOLOGY 2 0 16

THE 15 ™ NATIONAL CONGRESS

High Risk Plaque Definition

-0 75 1 00

S t eno s is>5 0 % and G end e r ; AOC a rea : 0 8

S t enosis >5 0 %, G en d er and ROMICAT score ; AO C area: 0 9 1

Refere n ce

High Risk Plaque Definition

Thank You

Focused Cardiac Ultrasound

Cardiac CT Perfusion

Therapeutic Ultrasound

CAC - 15 year prediction

High Risk Plaque THE 15 ra NATIONAL CONGRESS

OF CARDIOLOGY 2 0 16