Jeong A Kim

Korean Guidelines for the Appropriate Use of Cardiac CT

The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.

2017 Multimodality Appropriate Use Criteria for Noninvasive Cardiac Imaging: Expert Consensus of the Asian Society of Cardiovascular Imaging

In 2010, the Asian Society of Cardiovascular Imaging (ASCI) provided recommendations for cardiac CT and MRI, and this document reflects an update of the 2010 ASCI appropriate use criteria (AUC). In 2016, the ASCI formed a new working group for revision of AUC for noninvasive cardiac imaging. A major change that we made in this document is the rating of various noninvasive tests (exercise electrocardiogram, echocardiography, positron emission tomography, single-photon emission computed tomography, radionuclide imaging, cardiac magnetic resonance, and cardiac computed tomography/angiography), compared side by side for their applications in various clinical scenarios. Ninety-five clinical scenarios were developed from eight selected pre-existing guidelines and classified into four sections as follows: 1) detection of coronary artery disease, symptomatic or asymptomatic; 2) cardiac evaluation in various clinical scenarios; 3) use of imaging modality according to prior testing; and 4) evaluation of cardiac structure and function. The clinical scenarios were scored by a separate rating committee on a scale of 1–9 to designate appropriate use, uncertain use, or inappropriate use according to a modified Delphi method. Overall, the AUC ratings for CT were higher than those of previous guidelines. These new AUC provide guidance for clinicians choosing among available testing modalities for various cardiac diseases and are also unique, given that most previous AUC for noninvasive imaging include only one imaging technique. As cardiac imaging is multimodal in nature, we believe that these AUC will be more useful for clinical decision making.

Functional classification of aortic regurgitation using cardiac computed tomography: comparison with surgical inspection

In patients with aortic regurgitation (AR), a precise preoperative assessment of aortic valve (AV) pathology is important if AV repair or sparing operation is an alternative option. The aim of this study was to assess the diagnostic accuracy of computed tomography (CT) for evaluating the AR mechanism compared with surgical inspection. 59 patients with AR who underwent AV surgery and preoperative cardiac CT were evaluated. AR mechanism was classified into type 1 (aortic dilatation or cusp perforation), type 2 (prolapsed cusp) and type 3 (cusp retraction). Agreement between CT and surgical inspection was obtained. Correlation between aortic regurgitant orifice (ARO) and imaging parameters were evaluated. On surgical inspection, type 1 AR was noted in 22 patients, type 2 in 16 and type 3 in 21. Agreement regarding the AR mechanism on CT was excellent (intra-class correlation coefficient, 0.81). At the patient level, the Cohen’s κ value for CT findings with surgical inspection was of 0.89. At the cusp level, moderate agreement was noted between CT and surgical inspection. In the per-cusp analysis, CT had a sensitivity of 72.6%, specificity of 85.1%, positive predictive value of 73.8% and negative predictive value of 84.3% for the detection of aortic cusp abnormality. The diameter, perimeter and area of aortic annulus had moderate correlation with ARO (r = 0.54–0.66, P < 0.001). CT-derived classification of AR mechanism showed excellent agreement with surgical inspection.