Michael F. Gilson

ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents

This document has been developed as an Expert Consensus Document (ECD) by the American College of Cardiology Foundation (ACCF), American Association for Clinical Chemistry (AACC), American College of Chest Physicians (ACCP), American College of Emergency Physicians (ACEP), American College of

Positron emission tomographic measurements of absolute regional myocardial blood flow permits identification of nonviable myocardium in patients with chronic myocardial infarction

OBJECTIVES This study tested the hypothesis that nonviable myocardium can be identified by quantitative measurements of regional myocardial blood flow obtained using positron emission tomography in conjunction with a mathematical model of nitrogen-13 (N-13) ammonia tracer kinetics. BACKGROUND Under steady state basal conditions there is a minimal level of blood flow required to sustain myocardial viability. Therefore, the hypothesis predicts that regions with flow below a certain threshold are likely to be composed primarily of scar. METHODS Studies were conducted in 26 patients with chronic myocardial infarction. Positron emission tomographic measurements of basal regional myocardial blood flow (N-13 ammonia) and fluorine-18 (F-18) fluorodeoxyglucose uptake were made and correlated with information about coronary anatomy and regional wall motion to assess myocardial viability. RESULTS In patients with chronic myocardial infarction, normal zone blood flow (0.81 +/- 0.32 ml/min per g [mean +/- SD]) was greater (p < 0.02) than that of border zones (0.59 +/- 0.29 ml/min per g), which in turn exceeded (p < 0.001) that of infarct zone flow (0.27 +/- 0.17 ml/min per g). Good correlation was noted between relative F-18 fluorodeoxyglucose uptake and relative regional myocardial blood flow in all zones (r = 0.63, p < 0.001). Mismatch between blood flow and F-18 fluorodeoxyglucose uptake, with a single exception, was not observed in any segment with blood flow < 0.25 ml/min per g. All dyskinetic segments (n = 5) also had blood flow < 0.25 ml/min per g. In contrast, 43 of 45 myocardial segments (23 patients) with normal contraction or only mild hypokinesia had flow > or = 0.39 ml/min per g (average flow 0.78 +/- 0.35 ml/min per g). CONCLUSIONS In patients with chronic myocardial infarction, myocardial viability is unlikely when basal regional myocardial blood flow is < 0.25 ml/min per g. Average basal flow in segments with normal or nearly normal wall motion is 0.78 +/- 0.35 ml/min per g. Thus, positron emission tomographic measurement of regional myocardial blood flow is helpful in identifying nonviable myocardium in these patients.

2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement: Developed in collaboration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery

American College of C Surgeons Representa tative; xThe Society f tative; kSociety of {Society for Cardiov Society of America R Surgery Representati tative; zzAmerican He Advocate, Patient R Representative. Author Recusals: Writi from voting on sectio entities may apply; se This document was app (ACCF) Board of Tru Council, Society for C of Directors, Society 2012 and endorsed b (AHA) Science Adv Echocardiography (A (EACTS), Heart Fail Cardiovascular Anest phy (SCCT), and the January 2012. For the the ACCF Board of T ument, is available at: Officers-and-Trustees industry to the docum vote on approval. David R. Holmes, Jr, MD, FACC, Chair,* Michael J. Mack, MD, FACC, Vice Chair,y Sanjay Kaul, MBBS, FACC, Vice Chair,* Arvind Agnihotri, MD,z Karen P. Alexander, MD, FACC,* Steven R. Bailey,MD, FACC, FSCAI,x John H. Calhoon,MD,z Blase A. Carabello, MD, FACC,* Milind Y. Desai, MBBS, FACC,k,{ Fred H. Edwards, MD, FACC,y Gary S. Francis, MD, FACC, Timothy J. Gardner, MD, FACC,y A. Pieter Kappetein, MD, PhD,** Jane A. Linderbaum, MS, CNP, AACC,* Chirojit Mukherjee, MD,yyDebabrataMukherjee, MD, FACC,* CatherineM. Otto, MD, FACC,* Carlos E. Ruiz, MD, PhD, FACC, FSCAI,x Ralph L. Sacco, MD, MS, FAHA,zz Donnette Smith,xx and James D. Thomas, MD, FACCkk

2012 American college of cardiology foundation/society for cardiovascular angiography and interventions expert consensus document on cardiac catheterization laboratory standards update: American college of cardiology foundation task force on expert consensus documents society of thoracic surgeons society for vascular medicine

WRITING COMMITTEE MEMBERS* Thomas M. Bashore, MD, FACC, FSCAI, chair, Stephen Balter, PhD, FAAPM, FACR, FSIR, Ana Barac, MD, PhD, John G. Byrne, MD, FACC, Jeffrey J. Cavendish, MD, FACC, FSCAI, Charles E. Chambers, MD, FACC, FSCAI, James Bernard Hermiller, Jr, MD, FACC, FSCAI, Scott Kinlay, MBBS, PhD, FACC, FSCAI, Joel S. Landzberg, MD, FACCk, Warren K. Laskey, MD, MPH, FACC, FSCAI, Charles R. McKay, MD, FACC, Julie M. Miller, MD, FACC, David J. Moliterno, MD, FACC, FSCAI, John W.M. Moore, MD, MPH, FACC, FSCAI, Sandra M. Oliver-McNeil, DNP, ACNP-BC, AACC, Jeffrey J. Popma, MD, FACC, FSCAI, and Carl L. Tommaso, MD, FACC, FSCAI

2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement: developed in collaboration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance.

American College of C Surgeons Representa tative; xThe Society f tative; kSociety of {Society for Cardiov Society of America R Surgery Representati tative; zzAmerican He Advocate, Patient R Representative. Author Recusals: Writi from voting on sectio entities may apply; se This document was app (ACCF) Board of Tru Council, Society for C of Directors, Society 2012 and endorsed b (AHA) Science Adv Echocardiography (A (EACTS), Heart Fail Cardiovascular Anest phy (SCCT), and the January 2012. For the the ACCF Board of T ument, is available at: Officers-and-Trustees industry to the docum vote on approval. David R. Holmes, Jr, MD, FACC, Chair,* Michael J. Mack, MD, FACC, Vice Chair,y Sanjay Kaul, MBBS, FACC, Vice Chair,* Arvind Agnihotri, MD,z Karen P. Alexander, MD, FACC,* Steven R. Bailey,MD, FACC, FSCAI,x John H. Calhoon,MD,z Blase A. Carabello, MD, FACC,* Milind Y. Desai, MBBS, FACC,k,{ Fred H. Edwards, MD, FACC,y Gary S. Francis, MD, FACC, Timothy J. Gardner, MD, FACC,y A. Pieter Kappetein, MD, PhD,** Jane A. Linderbaum, MS, CNP, AACC,* Chirojit Mukherjee, MD,yyDebabrataMukherjee, MD, FACC,* CatherineM. Otto, MD, FACC,* Carlos E. Ruiz, MD, PhD, FACC, FSCAI,x Ralph L. Sacco, MD, MS, FAHA,zz Donnette Smith,xx and James D. Thomas, MD, FACCkk