Current Status of Patient Radiation Exposure of Cardiac Positron Emission Tomography and Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging.

Background: Radiation exposure during nuclear cardiology procedures has received much attention and has prompted citations for radiation reduction. In 2010, the American Society of Nuclear Cardiology recommended reducing the average patient study radiation exposure to <9 mSv in 50% of studies by 2014. Cardiac positron emission tomography (PET) for myocardial perfusion imaging (MPI) has emerged within recent years, but current radiation exposure in cardiac nuclear PET laboratories is unknown.

The Future of Cardiac Imaging: Report of a Think Tank Convened by the American College of Cardiology.

The American College of Cardiology's Executive Committee and Cardiovascular Imaging Section Leadership Council convened a discussion regarding the future of cardiac imaging among thought leaders in the field during a 2 day Think Tank. Participants were charged with thinking broadly about the future of imaging and developing a roadmap to address critical challenges. Key areas of discussion included: 1) how can cardiac imaging services thrive in our new world of value-based health care? 2) Who is the cardiac imager of the future and what is the role of the multimodality imager? 3) How can we nurture innovation and research in imaging? And 4) how can we maximize imaging information and optimize outcomes? This document describes the proceedings of this Think Tank.

Acid-base optimization during hypothermia.

Cardiac arrest (CA) often results in hemodynamic and metabolic compromise with associated poor prognosis. Therapeutic hypothermia (TH) has become the standard of care for CA survivors, decreasing reperfusion injury and intercellular acid-base disturbances, with improved neurologic outcomes. These benefits are realized despite a mild acidosis that can potentially occur during TH.

Relationship between quantitative cardiac neuronal imaging with ¹²³I-meta-iodobenzylguanidine and hospitalization in patients with heart failure.

Purpose: Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by (123)I-meta-iodobenzylguanidine ((123)I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between (123)I-mIBG imaging findings and hospitalization.

Managing the Complications of Mild Therapeutic Hypothermia in the Cardiac Arrest Patient.

Mild therapeutic hypothermia (MTH) is used to lower the core body temperature of cardiac arrest (CA) patients to 32°C from 34°C to provide improved survival and neurologic outcomes after resuscitation from in-hospital or out-of-hospital CA. Despite the improved benefits of MTH, there are potentially unforeseen complications associated during management. Although the adverse effects are transient, the clinician should be aware of the associated complications when managing the patient receiving MTH.

The impact of severe acidemia on neurologic outcome of cardiac arrest survivors undergoing therapeutic hypothermia.

Introduction: Therapeutic Hypothermia (TH) has become a standard of care in improving neurological outcomes in cardiac arrest (CA) survivors. Previous studies have defined severe acidemia as plasma pH<7.20.

The occurrence of shivering in cardiac arrest survivors undergoing therapeutic hypothermia is associated with a good neurologic outcome.

Background: The incidence of shivering in cardiac arrest survivors who undergo therapeutic hypothermia (TH) is varied. Its occurrence is dependent on the integrity of multiple peripheral and central neurologic pathways. We hypothesized that cardiac arrest survivors who develop shivering while undergoing TH are more likely to have intact central neurologic pathways and thus have better neurologic outcome as compared to those who do not develop shivering during TH.

Major adverse cardiac events among postpercutaneous coronary intervention patients on clopidogrel and proton pump inhibitors.

Objective: To determine if concomitant use of proton pump inhibitors (PPIs) and clopidogrel is associated with adverse events among postpercutaneous coronary intervention (PCI) patients.

Methods: This is a single-center, retrospective case-control study of 3,287 consecutive patients on clopidogrel who underwent PCI. Univariate and multivariate analyses determined if concomitant PPI and clopidogrel use was associated with major adverse cardiac events (MACE).

Medical subspecialty hospitalist programs.

Hospital medicine is the fastest growing medical specialtyin the United States. Time pressures on primary-care physicians in the office and cost pressures on hospitals are the main driving forces behind this movement. Despite initial criticism and skepticism, hospitalist programs have proven cost effective in clinical and academic departments of internal medicine.

Risk stratification of CAD with SPECT-MPI in women with known estrogen status.

Objective: To compare exercise tolerance testing (ETT) with gated single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) risk stratification in women with an intermediate to high CAD pretest risk and known estrogen status (ES).

Background: SPECT-MPI is an effective test for risk stratifying patients with stable angina. However in women, the current guidelines recommend the exercise tolerance testing (ETT) as first line test.

Therapeutic hypothermia is associated with improved neurologic outcome and survival in cardiac arrest survivors of non-shockable rhythms.

Background: Therapeutic hypothermia improves neurologic outcomes in patients resuscitated from cardiac arrest due to ventricular fibrillation. However, its role in patients with cardiac arrest due to non-shockable rhythms (pulseless electrical activity (PEA) and asystole) is unclear. We hypothesized that therapeutic hypothermia favorably impacts neurologic outcome and survival in patients resuscitated from cardiac arrest due to non-shockable rhythms.

The use of hypothermia therapy in cardiac arrest survivors.

The annual incidence of out-of-hospital cardiac arrests in the United States is ∼350,000-450,000 per year. The prognosis for cardiac arrest survivors remains extremely poor. Therapeutic hypothermia (TH) is the only therapy proven to improve survival and neurological outcome in these patients.

Use of prehospital electrocardiograms for the treatment of patients with ST-segment elevation myocardial infarction.

Use of prehospital electrocardiograms (ECG) by emergency medical personnel may reduce door-to-balloon (DTB) time in patients with ST-segment elevation myocardial infarction (STEMI) referred for urgent percutaneous coronary intervention (PCI). A 79-year-old female awoke from sleep with severe substernal chest pain and called 911 for assistance. The patient was initially evaluated by advanced life support paramedics who performed a 12-lead ECG at the patient's home.

Statin use in the metabolic syndrome.

The metabolic syndrome is a condition associated with obesity, insulin resistance, hypertension, dyslipidemia, hypercoagulability, and chronic inflammation, all of which increase the risk of cardiovascular disease (CVD). The Third National Cholesterol Education Program Adult Treatment Panel extensively discussed the metabolic syndrome because it is a major health issue in the United States due to the national epidemic of obesity. Statins cause significant CVD risk reduction in patients with the metabolic syndrome by alterations in lipid levels and possibly by decreasing inflammation.