An Opportunity to Seize From Low Hanging Fruits: Capitalising on Incidentally Reported Coronary Artery Calcification.

Aim: We investigated the prevalence of incidental coronary artery calcifications (CAC) from non-electrocardiogram (ECG)-gated computed tomography (CT) chest (both contrast and non-contrast) for inpatients. We also assessed for downstream investigation and statin prescription from the inpatient teams. Incidental CAC are frequent findings on non-ECG-gated CT chest.

Review article: Accuracy of emergency physician performed point-of-care ultrasound of the thoracic aorta: A systematic review and narrative synthesis of the literature.

Point-of-care ultrasound (POCUS) is becoming ubiquitous in emergency medicine. POCUS for abdominal aortic aneurysm is well established in practice. The thoracic aorta can also be assessed by POCUS for dissection and aneurysm and transthoracic echocardiography is endorsed by international guidelines as an initial test for thoracic aortic pathologies.

Opportunities and Challenges of Computed Tomography Coronary Angiography in the Investigation of Chest Pain in the Emergency Department-A Narrative Review.

Chest pain is one of the most common presentations to emergency departments. However, only 5.1% will be diagnosed with an acute coronary syndrome, representing considerable time and expense in the diagnosis and investigation of the patients eventually found not to be suffering from an acute coronary syndrome.

MINOCA: under recognized and affecting predominantly female patients-an Australian experience.

Background: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is now being recognized as an important clinical entity with prognostic implications. There are limited data in relation to MINOCA in our local Australian settings.

Aim: We investigated the prevalence, clinical characteristics, major adverse cardiovascular events (MACE), and 1-year mortality of patients with MINOCA at Peninsula Health.

Resource implications following expansion of computed tomography coronary angiography: An Australian experience.

Introduction: To determine the downstream utilisation of Computed Tomography Coronary Angiography (CTCA) in a single Australian tertiary centre.

Methods: A single-centre retrospective study analysed 1460 patients undergoing CTCA between 1st January 2015 to 31st December 2018 at a tertiary hospital in Victoria, Australia, with a catchment area of 500,000 people. The coronary stenosis grading, plaque characteristics and coronary calcium score were identified.

Discrepancies in post-ST-elevation myocardial infarction care in women compared with men: evaluating for implicit bias-a single-centre study.

Background: Recent research has demonstrated discrepancies in care post-ST-elevation myocardial infarction (STEMI), showing that women often have delays in time to percutaneous coronary intervention (PCI) and are less often prescribed evidence-based medications for secondary prevention. This single-centre study evaluated gender differences in management and local prescribing patterns of STEMI patients on discharge consistent with implicit bias, benchmarked against Australian clinical guidelines.

Method And Result: A retrospective, consecutive study of 318 patients admitted with a STEMI was conducted at a large tertiary hospital from January 2018 until October 2019.

Site qualification and clinical interpretation standards for Tc-SPECT perfusion imaging in a multi-center study of MITNEC (Medical Imaging Trials Network of Canada).

Background: Qualification and interpretation standards are essential for establishing Tc-SPECT MPI accuracy vs. alternative modalities.

Methods: Rest-stress Tc-SPECT phantom scans were acquired on 35 cameras.

Appropriate Use Criteria for Cardiac Computed Tomography: Impact on Diagnostic Utility.

Background: Appropriate Use Criteria (AUC) guidelines for cardiac computed tomography (CCT) were developed to limit testing to reasonable clinical settings. However, significant testing is still done for inappropriate indications. This study investigates the impact of AUC on evaluability of CCT to determine if inappropriate tests result in a greater proportion of nondiagnostic results.

Appropriate Use Criteria for Cardiac Computed Tomography: Does Computed Tomography Have Incremental Value in All Appropriate Use Criteria Categories?

Purpose: Cardiac imaging expenditures have come under scrutiny, and a focus on appropriate use criteria (AUC) has arisen to ensure cost-effective resource utilization. Although AUC has been developed by clinical experts, it has not undergone rigorous quality assurance testing to ensure that inappropriate indications for testing yield little clinical benefit. The objective of the study was to evaluate the potential incremental prognostic value of coronary computed tomographic angiography (CCTA) in the different AUC categories.

Using coronary calcification to exclude an ischemic etiology for cardiomyopathy: A validation study and systematic review.

Background: Preliminary data suggests the absence of coronary artery calcification (CAC) excludes ischemic etiologies of cardiomyopathy. We prospectively validate and perform a systematic review to determine the utility of an Agatston score=0 to exclude the diagnosis of ischemic cardiomyopathy.

Methods And Results: Patients with newly diagnosed LV dysfunction were prospectively enrolled.

Single CT for attenuation correction of rest/stress cardiac SPECT perfusion imaging.

Common practice is to use separate CT scans acquired during rest and stress for attenuation correction of SPECT myocardial perfusion imaging (MPI). We evaluated using a single CT scan to correct both rest and stress SPECT scans. Studies from 154 patients were reprocessed using one CT acquired at stress to correct both rest and stress scans (1CT) and compared to correction of each scan with its own CT (2CT).

Canceled coronary computed tomography angiography: Downstream testing and outcomes.

Background: Downstream resource utilization and its impact on outcomes after a canceled CCTA have not been well studied. We sought to understand downstream resource utilization and patient outcomes after canceled CCTA.

Methods And Results: Consecutive patients were prospectively enrolled into an institutional cardiac CT registry.

Meta-analysis of admission hyperglycaemia in acute myocardial infarction patients treated with primary angioplasty: a cause or a marker of mortality?

Aims: Admission hyperglycaemia (AH) has been associated with worse outcomes in acute myocardial infarction (AMI). In the current review, we evaluated the impact of primary angioplasty (pPCI) on mortality in AMI patients with AH. Our second aim was to evaluate if AH is a marker of baseline risk or an independent predictor of mortality.

Left atrial band: a rare congenital anomaly.

Left atrial fibromuscular band is a rare congenital cardiac anomaly. We present a patient with an incidental finding of left atrial band on an intra-operative transesophageal echocardiogram and characterize its appearance on two-dimensional and three-dimensional echocardiograms.

The nuts and bolts of pills and portions: the functions of a drug safety working group.

Hospitalised patients commonly experience adverse drug events (ADEs) and medication errors. Runciman reported that ADEs in hospitals account for 20% of reported adverse events and contribute to 27% of deaths where death followed an adverse event. Hughes recommends multidisciplinary hospital drug committees to assess performance and raise standards.