ASNC2020 Heats Up with Cases from Ottawa Heart Institute
The ASNC2020 Cases with the Aces session "We the North: Hot Cases from Cold Weather" engaged learners from nearly 30 countries, with attendees directing a steady flow of insightful questions to presenters from the Ottawa Heart Institute.
Moderators Gary R. Small, MBChB, PhD, and Benjamin Chow, MD, FASNC, presented seven in-depth cases showing a mix of common CAD presentations as well as sarcoidosis, endocarditis, and transplant vasculopathy. Taken together, the cases demonstrated the utility of SPECT, PET, and FDG-PET and "reinforced the continued improvement in clinical care through high-quality imaging."
Dr. Small offered a glimpse into "A Day in the Life of Ottawa," by sharing "the 7 C's" the team applies to ensure they are continually improving quality: Consistent: uniformity of reporting; Confidence: fulfilling the expectations of referring physicians; Cogent and coherent; Concise reporting; Conscientious; Collegiate; and Correct, meaning precise and accurate.
Drs. Chow and Small were joined by ASNC2020 Program Chair Terrence Ruddy, MD, MASNC, Rob Beanlands, MD, MASNC, Robert DeKemp, PhD, FASNC, and R. Glenn Wells, PhD, to interpret the cases, emphasize teaching points, and field questions that ranged from technical to controversial. Discussion points included:
- When to use prone imaging vs. attenuation correction or CT;
- The potential and practicality of SPECT myocardial blood flow for assessing individual vessels;
- Why it is crucial to have an established pathway for outpatient patients whose studies reveal high risk and need for urgent admission;
- What "coronary steal" is and how to calculate it;
- How to apply ISCHEMIA trial results;
- How myocardial blood flow values can be used to assess the likelihood of transplant vasculopathy;
- The difference between flow reserve and delta myocardial flow, and how to use each;
- Why it is important to review whole-body FDG-PET images;
- How three-hour 99m-Tc PYP can move a study from screening for cardiac amyloidosis to confirmatory;
- The complexities of managing sarcoidosis patients;
- Plus much more.