Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

MR Safety Issues Particular to Women

Because of its lack of ionizing radiation, MR imaging is increasingly used for patients with cardiovascular disease, including young women. However, the risks related to the MR environment need to be acknowledged and prevented. For women, there are unique gender-related safety issues that are important to address in cardiovascular MR examinations. This article familiarizes radiologists with MR safety issues and current, evidence-based recommendations for specific situations such as pregnancy or lactation and imaging of women who have pelvic gynecologic devices such as intrauterine devices. Practical algorithms to minimize risk and increase MR safety for these women are suggested

Optimal imaging protocol for measuring dynamic expiratory collapse of the central airways

AIM: To compare measurements of expiratory collapse obtained using multidetector computed tomography (MDCT) of the central airways on routine axial and multiplanar reformatted (MPR) images. MATERIALS AND METHODS: Fifty volunteers with normal pulmonary function and no smoking history were imaged using a 64 MDCT system (40 mAs, 120 kVp, 0.625 mm collimation) with spirometric monitoring at end-inspiration and during forced expiration. Measurements of the trachea, right main (RMB) and left main bronchus (LMB) were obtained on axial and MPR images. Inspiratory and dynamic-expiratory cross-sectional area (CSA) measurements were used to calculate the mean percentage expiratory collapse (% Collapse). A paired t-test was used to assess within-subject differences and a Bland-Altman plot was used to assess agreement between the methods. RESULTS: Among 24 men and 26 women (mean age +/- standard deviation 50 +/- 15 years), CSA values were significantly greater on axial than MPR images (all p&lt;0.001); however, the mean difference in % Collapse values for axial versus MPR were small: trachea approximate to 1% (55 +/- 19 versus 56 +/- 18, p = 0.338); LMB identical (60 +/- 20 versus 60 +/- 17 p = 0.856); and, RMB 4% (62 +/- 19 versus 66 +/- 19 p&lt;0.001). On average, creation of MPR required 12 minutes of additional time per case (range = 10-15 min). CONCLUSION: Differences in mean % Collapse for axial versus MPR images were small and unlikely to influence clinical management. This finding suggests that MPR may not be indicated for routine assessment of central airway collapse

Cine MRI of Tracheal Dynamics in Healthy Volunteers and Patients With Tracheobronchomalacia

OBJECTIVE. Bronchoscopy and MDCT are routinely used to assess tracheobronchomalacia (TBM). Recently, dynamic MRI (cine MRI) has been proposed as a radiation-free alternative to MDCT. In this study, we tested cine MRI assessment of airway dynamics during various breathing conditions and compared cine MRI and MDCT measurements in healthy volunteers and patients with suspected TBM. CONCLUSION. Cine MRI was found to be a technically feasible alternative to MDCT for assessing central airway dynamics