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Volume 9, Supplement 1, 2008

Volume 9, Supplement 1, 2008

Table of Contents

Introduction Optimizing Outcomes in CT Imaging
Priceless Clinical Pearls in the Performance of Cardiac CT Optimizing Outcomes in CT Imaging
Cardiovascular CT represents an important innovation in cardiac imaging as a oninvasive modality for the diagnosis of coronary artery disease. As a screening examination, coronary CT has the ability to identify the presence, extent, location, and severity of coronary artery disease in patients at risk. As a diagnostic examination in patients with chest discomfort and dyspnea, it can not only evaluate for the presence of coronary artery disease but also evaluate the pulmonary vasculature and aorta. The ability to perform high-quality cardiac CT requires a combination of technical expertise and knowledge of cardiac anatomy. From our experience having performed over 6000 cardiac CTs, we provide the reader with a number of clinical and technical pearls that will enhance his or her ability to perform high-quality studies even in the more challenging patient. [Rev Cardiovasc Med. 2008;9(suppl 1):S3-S13]
Iodinated Contrast Media and the Kidney Optimizing Outcomes in CT Imaging
One of the principal complications of radiographic procedures utilizing intravascular iodinated contrast media is acute kidney injury. Although several clinical and procedural factors impact a patient’s risk for contrast-induced acute kidney injury (CIAKI), substantial attention has been focused on the relationship between the type of contrast agent used and renal injury. Multiple contrast agents are available for clinical use, each defined by a series of physicochemical properties. The evolution from high osmolal to low osmolal and, more recently, iso-osmolal contrast media has led to several clinical trials and meta-analyses comparing the nephrotoxicity of different contrast agents. This article summarizes the physicochemical properties that define and differentiate iodinated contrast media, discusses the purported relationship between these properties and kidney injury, and describes the salient findings of clinical trials and meta-analyses that have compared the nephrotoxic effects of contrast agents. Although ongoing and future studies will further elucidate our understanding of the relationship between iodinated contrast and risk for CIAKI, a sound understanding of the currently available data will help inform evidence-based decisions on the use of these agents in clinical practice. [Rev Cardiovasc Med. 2008;9(suppl 1):S14-S23
Contrast Media: Procedural Capacities and Potential Risks Optimizing Outcomes in CT Imaging
Contrast media are known to have transient hemodynamic properties that can influence a patient’s clinical status, including heart rate variability and blood pressure. These changes have the potential to impact the diagnostic quality of CT scans. Although most patients are able to receive contrast media without significant adverse reactions, events occur in a minority of cases. These reactions range from mild discomfort (injection-associated pain and heat sensation) to more significant cardiac, renal, and hypersensitivity reactions. The incidence of adverse reactions varies with the type of contrast media used, and several randomized trials have elucidated the cardiac and renal differences among agents. Risk factors for contrast-induced acute kidney injury (CIAKI) have been established, with baseline kidney disease amplified by the presence of diabetes constituting the highest-risk patient group. Strategies for preventing CIAKI include antioxidant therapy, hydration regimens, and choice of contrast agents. Enhanced knowledge on the part of physicians and medical personnel regarding the properties and potential side effects of iodinated contrast agents should lead to improved patient safety and efficacy when performing radiologic examinations. [Rev Cardiovasc Med. 2008;9(suppl 1):S24-S34]
Interventional Radiology Procedures: Addressing the Needs of the Cardiovascular Patient Optimizing Outcomes in CT Imaging
Interventional radiologists perform a wide range of procedures on virtually every organ system in the body. Technological advances continue to expand the repertoire of procedures in this field, challenging the frontiers of medical science and individual expertise. With cardiovascular disease being the number 1 cause of death in the United States and an aging population before us, physicians who perform minimally invasive procedures must be knowledgeable regarding unique aspects of cardiovascular management as it pertains to the catheterization laboratory. Specific areas addressed in this review include anesthesia, hypertension, and chronic kidney disease. [Rev Cardiovasc Med. 2008;9(suppl 1):S35-S43]
Self-Assessment Post-Test Optimizing Outcomes in CT Imaging