by
Robert Garment, Executive Editor | March 16, 2016
From the March 2016 issue of HealthCare Business News magazine
One of the benefits of cardiac MRI is there’s no radiation, says Dr. Garima Sharma, a cardiologist at Johns Hopkins Medicine in Baltimore. Still, the experience can be challenging for patients if they become claustrophobic, since it takes an hour to do the scan. Pregnant women are advised not to have cardiac MRIs done, and it’s also not a good fit for patients with renal failure, she says.
We put this question to Sharma: All things being equal, when do you recommend an MRI, when do you recommend CT, and when do you recommend ultrasound? She replied:
CT: If I want to answer the question of chest pain related to coronary artery disease, or when a patient has an inconclusive stress test, CT is best. A CT scan looks at the absence or presence of significant coronary artery disease. It is also a great test for cardiac masses, especially thrombus in the heart and congenital heart disease and postoperative changes.
MRI: This sophisticated technology is aimed at evaluating the accurate function of the heart. It is reserved for specific questions such as: masses, congenital abnormalities and infiltrative disorders such as cardiac sarcoid, amyloid and iron overload syndrome. It’s also used for evaluating scarring after MI and assessing myocardial recovery and damage, and also evaluating the pericardium. Echocardiology: regular testing, first line test for structure and function.
Cardiac CT
Sharma is a big supporter of CT scanning in cardiology. “If a patient comes in with coronary disease and has an abnormal EKG, CT scans are really great, because they tell you one thing for sure: Is there or is there not heart disease?” says Sharma, a member of the ACC’s Early Career Council.
According to Sharma, numerous papers have been written about the use of cardiac CT in the last 10 to 15 years — and that means there are now very good guidelines for the use of the technology. Of course, cardiac CT also has its disadvantages, which include the need to do additional testing to determine why a patient is suffering from chest pain, she says.
Transcatheter aortic valve replacement
Freeman is excited about what he describes as “an absolute explosion in percutaneous valve therapy.” Transcatheter aortic valve replacement (TAVR) is one such procedure, as is the soon-to-come-out percutaneous mitral valve repair (MVR).
