ASNC's thoughts on the AHA/ACC chest pain guidelines

Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2022: single photon emission computed tomography

In this review, we will summarize a selection of articles on single-photon emission computed tomography published in the Journal of Nuclear Cardiology in 2022. The aim of this review is to concisely recap major advancements in the field to provide the reader a glimpse of the research published in the journal over the last year. This review will place emphasis on myocardial perfusion imaging using single-photon emission computed tomography summarizing advances in the field including in prognosis, non-perfusion variables, attenuation compensation, machine learning and camera design. It will also review nuclear imaging advances in amyloidosis, left ventricular mechanical dyssynchrony, cardiac innervation, and lung perfusion. We encourage interested readers to go back to the original articles, and editorials, for a comprehensive read as necessary but hope that this yearly review will be helpful in reminding readers of articles they have seen and attracting their attentions to ones they have missed.

Ischemia Trial: Does the Cardiology Community Need to Pivot or Continue Current Practices?

PURPOSE OF REVIEW

For decades, the standard of care for stable ischemic heart disease (SIHD) has been an ischemia-centric approach based on largely observational data suggesting a survival benefit of revascularization in patients with moderate-or-severe ischemia. In this article, we will objectively review the evolution of the ischemia paradigm, the trial evidence comparing revascularization to medical therapy in SIHD, and what contemporary practice should be in 2022.

RECENT FINDINGS

Randomized trials, including COURAGE and, most recently, the ISCHEMIA trial, have shown no reduction in "hard outcomes" like death and myocardial infarction (MI) in SIHD compared to medical therapy. The trial excluded high-risk patients with left main disease, low ejection fraction (EF) < 35%, and severe unacceptable angina. Irrespective of the severity of ischemia and the extent of coronary artery disease (CAD), revascularization did not offer any prognostic advantage over medical therapy. On the other hand, there was a durable improvement in symptoms. While there are many caveats to the ISCHEMIA trial, the overall strengths of the trial outweigh these limitations. The findings of ISCHEMIA are consistent with previous trials. It is time for the cardiology community to pivot towards medical therapy as the initial step for most patients with SIHD. Physicians should have the "COURAGE" to embrace "ISCHEMIA" and be comfortable with treating ischemia medically.