Cardiovascular Imaging: Year-in-Review 2015-2016 Adj Ass Prof Ong Hean Yee MBBCh BAO, ASCeXAM, FRCP, FESC Senior Consultant and Head of Department Department of Cardiology Khoo Teck
Trang 1Cardiovascular Imaging:
Year-in-Review 2015-2016
Adj Ass Prof Ong Hean Yee
MBBCh BAO, ASCeXAM, FRCP, FESC
Senior Consultant and Head of Department
Department of Cardiology
Khoo Teck Puat Hospital
Trang 2Astra Zeneca, Bayer
All Honorariums donated to Department Research and Training Fund
Trang 4Cardiovascular Imaging 2015-16
Focused Cardiac Ultrasound
Cardiac CT Perfusion
Therapeutic Ultrasound
CAC - 15 year prediction
High Risk Plaque
Trang 5Cardiovascular Imaging 2015-16
Focused Cardiac Ultrasound
Cardiac CT Perfusion
Therapeutic Ultrasound
CAC - 15 year prediction
High Risk Plaque
Trang 6J Am Soc Echocardiogr 2014; 27: 683, e1-e33
Focused Cardiac Ultrasound
Trang 7J Am Soc Echocardiogr 2014; 27: 683, e1-e33
Focused Cardiac Ultrasound
A&E ICU
Trang 8Acac Emerg Med 2015; 22: 536–541
Focused Cardiac Ultrasound
Trang 9Ascending Aorta measurement in A+E vs CT
Nazerian et al Acad Emerg Med 2015; 22: 536 Hypotension due to Cardiac Dysfunction vs Hypovelemia
Jones AE et al Shock
2005; 24: 513-7 Screening for HCM in Sports Clinic
Yim ES et al
J Ultrasound Med 2013; 32: 333-8
Use of hand held echo machine in underpriviledged
community
Fedson S JASE 2003;16:901-5 Clinical Examination versus handheld machine
Spencer KT
JACC 2001;37:2013-8
Focused Cardiac Ultrasound
Trang 10J Am Soc Echocardiogr 2014; 27: 683, e1-e33
Focused Cardiac Ultrasound
A&E ICU
=
?
Trang 11Cardiovascular Imaging 2015-16
Focused Cardiac Ultrasound
Cardiac CT Perfusion
Therapeutic Ultrasound
CAC - 15 year prediction
High Risk Plaque
Trang 13Topol Nissen Circulation 1995; 92: 2333-2342
Functional vs Anatomy
Underestimation and Oveestimation
Trang 14COURAGE NEJM March 2007 vol 356
Revascularisation by Anatomy
Trang 15Hachamovitch CIRC 2003, 107, 23: 2900
Revascularisation by Function
Trang 19Gonçalves et al JACC Img 2015; 8: 1322–35
CT perfusion
Trang 20Techasith JACC-Img 2011, 4: 905
CT perfusion
Aminophylline 1.5 mg/kg Dipyridamole 0.56 mg/kg/min
Trang 21EHJ Cardiovascular Imaging 2015 Mar 16 (3): 300
Trang 22EHJ Cardiovascular Imaging 2015 Mar 16 (3): 300
CT perfusion
Trang 23EHJ Cardiovascular Imaging 2015 Mar 16 (3): 300
CT perfusion
Trang 24Cardiovascular Imaging 2015-16
Focused Cardiac Ultrasound
Cardiac CT Perfusion
Therapeutic Ultrasound
CAC - 15 year prediction
High Risk Plaque
Trang 25Mathias JACC 2016; 67: 2506–15
Therapeutic Ultrasound
Trang 26Mathias JACC 2016; 67: 2506–15
Therapeutic Ultrasound
High Mechanical Index 1.1 - 1.3
Duration of Theraphy ~ 12 mins
Pulse Duration 3 – 20 s
Trang 27Mathias JACC 2016; 67: 2506–15
Myocardial Perfusion Score Index
Trang 28Cardiovascular Imaging 2015-16
Focused Cardiac Ultrasound
Cardiac CT Perfusion
Therapeutic Ultrasound
CAC - 15 year prediction
High Risk Plaque
Trang 2915 year warranty
J Am Coll Cardiol Img 2015; Aug 8 (8): 900-9
Trang 3015 year warranty
J Am Coll Cardiol Img 2015; Aug 8 (8): 900-9
Trang 3115 year warranty
J Am Coll Cardiol Img 2015; Aug 8 (8): 900-9
Trang 3215 year warranty
J Am Coll Cardiol Img 2015; Aug 8 (8): 900-9
Trang 33Cardiovascular Imaging 2015-16
Focused Cardiac Ultrasound
Cardiac CT Perfusion
Therapeutic Ultrasound
CAC - 15 year prediction
High Risk Plaque
Trang 34High Risk Plaques
J Carvdiovasc Computed Tomography 2015; 9: 538-545
J Am College Cardiol 2015; 66: 337-46
Trang 35High Risk Plaques
Falk and Fuster Circulation 1992, 92, (3): 657
Trang 36High Risk Plaques
Falk and Fuster Circulation 1992, 92, (3): 657
Trang 37High Risk Plaques / Stenosis
Motoyama JACC 2007; 50: 319–26
PR (Positive Remodelling) (Remodeling Index > 1.1)
LAP (Low Attenutation Plague) (< 30 Hounsfield Unit)
Significant Stenosis (> 70% luminal stenosis)
Trang 38High Risk Plaques
Motoyama et al J Am College Cardiol 2015; 66: 337-46
Trang 39High Risk Plaques
Significant Stenosis Only HR 2.89 High Risk Plaque Only HR 13.13
Motoyama JACC 2015; 66: 337-46
Trang 40High Risk Plaque Definition
Trang 41High Risk Plaque Definition
ROMICAT II JCCT 2015; 9: 538-545
Trang 42High Risk Plaque Definition
ROMICAT II JCCT 2015; 9: 538-545
Trang 43Thank You
Focused Cardiac Ultrasound Cardiac CT Perfusion
Therapeutic Ultrasound
CAC - 15 year prediction
High Risk Plaque