DOI: 10.1097/MNM.0b013e32833aa72e
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Issn Print: 0143-3636
Publication Date: 2010/06/01
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Excerpt
Avid readers of this newsletter may recall that in my report of the BNCS Annual meeting which appeared in the March issue of this journal I mentioned the NICE ‘Chest Pain of Recent Onset’ guidelines which looked set to change patient management. The British Nuclear Cardiology Society made a detailed response to the proposed guidelines and the final document was released in March 2010. Not having been a member of the consultation group I do not know what the draft actually stated and judging from what I wrote in my previous report the final guideline possibly doesn't differ greatly from the draft. Non-invasive functional imaging is suggested for ‘people without confirmed CAD in whom stable angina cannot be diagnosed or excluded based on clinical assessment alone when the estimated likelihood of CAD is 30–60%’. This estimate is based on age, sex, symptoms and risk factors such as diabetes, smoking and hyperlipidaemia. The type of functional imaging is to ‘take account of local availability, expertise and the person's contraindications and preferences’ and could be myocardial perfusion scintigraphy with adenosine, dipyridamole or dobutamine stress (not exercise or so it would seem), stress echocardiography (with exercise or dobutamine), first pass contrast-enhanced magnetic resonance perfusion or magnetic resonance imaging for stress induced wall motion abnormalities (with exercise or dobutamine). Magnetic resonance coronary angiography is not to be used to diagnose stable angina and exercise ECG is not to be used to diagnose or exclude stable angina in people without known CAD. We may therefore see an increase in requests for myocardial perfusion scintigraphy if exercise ECG is to be sidelined or we may see an increase in stress echocardiography.
When the estimated likelihood of CAD is 10–29% CT calcium scoring is to be offered as the first line diagnostic investigation. When the resultant score is between 1 and 400 64-slice CT angiography is to be offered however if the result of this is uncertain then functional imaging is ‘allowed’. When the estimated likelihood of CAD is 61–90% and invasive coronary angiography is not appropriate or acceptable and/or coronary revascularisation is not being considered then functional imaging can be offered. I wonder how many centres are currently offering 64-slice CT angiography and what the current level of expertise is on a local level.
A one day meeting will be held/has already been held at the Royal College of Physicians to facilitate the implementation of these guidelines. If any readers attended and would like to share their experience with us all please send me a report. Would any of the BNCS team like to comment?
It was brought to my attention a few months ago that I had managed to miss a number of new retirees so I have pleasure this month in bringing some more tributes. Keep them coming and remember that a black and white photograph can be included. We start with Ron Mistry……
Congratulations to Ron for his 40 years contribution to Nuclear Medicine. I was fortunate to have worked with Ron from the beginning of his 40 years, straight from school, when he was the first NM technician at Guys; working (as was traditional for Nuclear Medicine) in a cupboard in the basement.
