Medical Tribune June 2008 P1
David Brill
Doctors should wait for more clinical data before adopting the latest cardiac imaging techniques, according to a specialist.
“The technology is far outpacing the evidence, so what’s happening is that people are actually moving on to the next technique without properly evaluating the previous technique,” said Dr. Joseph Selvanayagam, a cardiologist at the Flinders Medical Center in Adelaide, Australia.
“What these modalities really need to work on is not necessarily to keep improving the technology … but to invest in clinical outcome studies that look at whether doing these tests in patients actually improves outcomes and reduces cost. Otherwise we will be criticized for purely being focused on the newest toy and not being focused on what’s actually best for the patient,” he said. “This is a real risk for everybody in this field.”
Speaking at the second congress of the Asian Society of Cardiovascular Imaging in Singapore, Selvanayagam told Medical Tribune that computed tomography (CT) is one such imaging modality where more clinical data is required.
“There are people who have become radical and are proposing [scanning] asymptomatic patients for indications which really there has not been data for. It’s something that we have to be careful of, particularly given that it’s a technique that has radiation and safety concerns,” he said.
Selvanayagam also addressed the role of cardiac magnetic resonance (CMR) as an initial test for assessing patients who present with acute cardiac disease – an application that is currently limited to a few high-volume centers owing to a lack of availability of scanners and concerns over the difficulties of monitoring and resuscitating patients during a scan. The relatively slow scanning speed of CMR is also problematic as patients are required to hold their breath, which can exclude those with chest pain.
Provided the patient is stable, however, CMR could become a routine first-line diagnostic test in suspected cases of cardiomyopathy, coronary artery disease and myocarditis, according to Selvanayagam. The versatility, high spatial resolution and three-dimensional nature of the technique offers an assessment of cardiac function beyond that which is possible with less specific tests such as electrocardiography, and can thereby assist with the diagnosis and triage
of these patients.
“I think in selected patients it will become a preferred technique,” he concluded. “I would encourage more centers to get adequate experience and training in CMR and once they have that, then to utilize it for these indications.”
David Brill
Doctors should wait for more clinical data before adopting the latest cardiac imaging techniques, according to a specialist.
“The technology is far outpacing the evidence, so what’s happening is that people are actually moving on to the next technique without properly evaluating the previous technique,” said Dr. Joseph Selvanayagam, a cardiologist at the Flinders Medical Center in Adelaide, Australia.
“What these modalities really need to work on is not necessarily to keep improving the technology … but to invest in clinical outcome studies that look at whether doing these tests in patients actually improves outcomes and reduces cost. Otherwise we will be criticized for purely being focused on the newest toy and not being focused on what’s actually best for the patient,” he said. “This is a real risk for everybody in this field.”
Speaking at the second congress of the Asian Society of Cardiovascular Imaging in Singapore, Selvanayagam told Medical Tribune that computed tomography (CT) is one such imaging modality where more clinical data is required.
“There are people who have become radical and are proposing [scanning] asymptomatic patients for indications which really there has not been data for. It’s something that we have to be careful of, particularly given that it’s a technique that has radiation and safety concerns,” he said.
Selvanayagam also addressed the role of cardiac magnetic resonance (CMR) as an initial test for assessing patients who present with acute cardiac disease – an application that is currently limited to a few high-volume centers owing to a lack of availability of scanners and concerns over the difficulties of monitoring and resuscitating patients during a scan. The relatively slow scanning speed of CMR is also problematic as patients are required to hold their breath, which can exclude those with chest pain.
Provided the patient is stable, however, CMR could become a routine first-line diagnostic test in suspected cases of cardiomyopathy, coronary artery disease and myocarditis, according to Selvanayagam. The versatility, high spatial resolution and three-dimensional nature of the technique offers an assessment of cardiac function beyond that which is possible with less specific tests such as electrocardiography, and can thereby assist with the diagnosis and triage
of these patients.
“I think in selected patients it will become a preferred technique,” he concluded. “I would encourage more centers to get adequate experience and training in CMR and once they have that, then to utilize it for these indications.”
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