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Interview about Nuclear Imaging and the 8th International Conference of Nuclear Cardiology (ICNC8)

Fast facts

Nuclear Cardiology is a non-invasive imaging technique to detect abnormalities of the blood flow of the heart and of the pumping function of the heart using small amounts of radioactive compounds. These tests are performed in the resting state and following exercise; comparison of the 2 image sets allows assessment of obstructive coronary artery disease and to assist in medical decision-making for patients with ischemia hear disease.



Introduction

ICNC8 will be held from 29 April to 2 May 2007 in Prague, Czech Republic, one of the most attractive cities in Eastern Europe for its architecture, and as well as for its rich history and culture. This venue marks the International Congress of Nuclear Cardiology’s first journey beyond the usual western European environment and will hopefully encourage many attendees from more eastern locales to attend this excellent conference.

The goal of ICNC8, a joint endeavour between the American Society of Nuclear Cardiology (ASNC), the European Association of Nuclear Medicine (EANM) and the European Society of Cardiology (ESC), is the emphasis on education and continued growth of cardiac imaging within nuclear cardiology.

In addition to the focus of ICNC8 on the needs of practitioners, the conference will also emphasise innovative cardiac imaging with nuclear cardiology and cardiac CT techniques. Researchers and policy makers in cardiac imaging will also have a variety of educational opportunities. Most importantly, however, is that ICNC will facilitate dialogue among experts and the clinical users of nuclear cardiology from around the world.

The Co-Chairs of the ICNC8 are Jeroen Bax (NL) and Robert Hendel (USA), who along with the Programme Committee Co-Chairs (Juhani Knuuti (FI), Frank Bengel (USA), Robert Gropler (USA) are proud of the upcoming programme.

In this article, Jeroen Bax (NL) and Robert Hendel (USA) underline and provide cited examples, for the Hospital Post, the latest innovations in Nuclear Cardiology (hereinafter referred to as NC), provide a preview on the content of ICNC8 and anticipate the future in NC.

Interview 

Their opinion on imaging techniques in nuclear cardiology :

JJB: “Over the past years, positron emission tomography (PET) has attracted a lot of attention; with this technique, absolute quantification of cardiac perfusion and metabolism is possible. At present, absolute quantification of these processes is only feasible with positron emission tomography. In addition, this technique has become more widely available in recent years. Assessment of cardiac metabolism has been used with PET for more than 2 decades; assessment of metabolism is important in the detection of viable myocardium in patients with left ventricular dysfunction and chronic coronary artery disease.”

RH: “Nuclear cardiology has its strength as a method, which may be utilised to assess the risk of patients with known or suspected heart disease, concerning developing subsequent cardiac events. Risk stratification is an integral part of the management of cardiac patients and as such, nuclear cardiology will continue to serve as a key non-invasive method in the management of cardiac patients. However, as the basis of nuclear medicine may be more than assessing perfusion, the key future area of growth will be in molecular imaging.”

Their opinion on the technological advances to be showcased at ICNC8. In addition, they “divulge” what type of innovations can be expected at ICNC8!

JJB: “Undoubtedly, the integration between multi-slice CT and positron emission tomography is the area of most technical development. Multi-slice CT has gained enormous attention over the last years. This technique allows non-invasive imaging of the coronary arteries. Initially, 4-slice CT systems were used, and recently 64-slice CT systems have been introduced. With high accuracy it is possible to assess non-invasively coronary artery calcium and coronary artery stenoses”

“In contrast to the anatomic evaluation of MSCT, nuclear myocardial perfusion imaging allows assessment of ischemia. With the introduction of PET-CT systems, it is now possible to integrate the anatomic information from MSCT with the hemodynamic information from PET. Fusion of the 2 image sets allows integrated evaluation of coronary artery stenoses. Indeed, MSCT and PET provide complementary information; the techniques should be considered as complementary, rather than competing.”

The integration of function and perfusion with NC imaging, using gated SPECT has matured. The majority of centers do now routinely perform gated SPECT and information on ischemia, scar tissue on the one hand and left ventricular ejection fraction and volumes on the other hand is derived.

Also, attenuation correction has matured and can be applied in the clinical setting.”

RH: “In addition, instruments incorporating CT within nuclear cardiology, cameras will continue to evolve and attenuation correction will be an ever-increasing part of what we use. Certainly with the use of a hybrid instrument such as SPECT/CT, attenuation correction will be readily available. Small “footprint” cameras will be displayed, ideal for in-office imaging, which has grown enormously in the USA. Thus, nuclear cardiology may be extended to practice out of a large hospital or institutional environment.”

Their opinions based on the implementation of nuclear cardiology in Europe vs. the United States:

JBB: “NC has become completely integrated in the daily management of patients with known or suspected coronary artery disease. In the diagnostic and prognostic work-up of these patients NC has been established as a highly accurate technique for diagnosis of coronary artery disease, with sensitivity of 80-90% and specificity (or normalcy rate) of 80-90%. Moreover, NC is extensively used in the evaluation of high-risk groups, such as patients with diabetes. An increasing prevalence of obesity is expected to drive the number of individuals with diabetes worldwide to more than 330 million by the year 2025.”
“Patients with type 2 diabetes have a 2–4-fold higher risk of a cardiovascular event than non-diabetic patients, and cardiovascular disease is the principal cause of death in patients with type 2 diabetes. There is thus a clear need to identify patients with type 2 diabetes who are at risk of cardiovascular events before the onset of symptoms. Accordingly, early identification of atherosclerosis and ischemia is needed; the recently reported DIAD trial by Professor Frans Wackers (chair ICNC6 and ICNC7) has highlighted the central role of NC in the detection of silent ischemia in patients with diabetes 2.
The results revealed that the prevalence of silent ischemia was 22% (one in 5) in asymptomatic patients with diabetes.”

“Similarly, the ERASE trial (where Robert Hendel was an Investigator) has demonstrated the role of NC for evaluation and risk stratification of patients presenting with chest pain to the emergency room. NC imaging improved emergency room triage decision making for patients with symptoms suggestive of acute cardiac ischemia without obvious abnormalities on initial ECG. With the use of NC, unnecessary hospitalisations were reduced among patients without acute ischemia, without reducing appropriate admission for patients with acute ischemia.”

RH: “In general, fewer hurdles to the general use of nuclear cardiology methods exist in the US, but there are still impediments, such as regulatory and political issues. However, nuclear cardiology has widespread acceptance and most cardiologists find these techniques to be invaluable for the evaluation and management of cardiac patients. Although myocardial perfusion imaging was initially developed as a method to detect coronary artery disease, its real value is in risk assessment. Even going beyond the evaluation of a general group of patients, SPECT myocardial perfusion imaging (MPI) has been shown to be highly effective in specialised groups such as women, diabetics, renal failure patients, and the elderly. ICNC8 will highlight these roles”.

ICNC8 Highlights:

JJB: “ICNC8 has instilled a simple formula that has proven to be a success amongst our attendees and faculty alike, that is, practical nuclear cardiology combined with basic science and new technology. Special read-with-the-expert sessions will allow the audience to share experience with NC experts. The core curriculum will address the state-of-the art in NC and its use in the daily clinical practice. New developments such as MSCT, PET-CT and molecular imaging will be highlighted in special sessions. Also, there is a growing need to integrate the different imaging modalities (echocardiography, MRI, MSCT and NC) and the use of multi-modality imaging in clinical practice will be addressed.”

RH: “ICNC8 will feature those recent advances in nuclear cardiology that have occurred since ICNC7. It will also provide the current or future practitioner with a “Core Curriculum” of information. Both cardiologists and radiologists will find sessions that will enhance their understanding of this important speciality. The advanced /investigative tracks will highlight evolving research in nuclear cardiology and cardiac CT, with a focus on new devices and radiopharmaceutics. As cardiac CT continues to grow and define its role in cardiovascular care, ICNC8 will feature a number of sessions devoted not only to cardiac CT but also to its integration with other modalities, including nuclear cardiology. Special sessions and satellite symposia will be offered with a variety of foci include an emphasis on women and heart failure. On of the most popular features of ICNC will return, with more than 8 dedicated “Read with the Expert” session, permitting small groups of registrants to interact with experts for the interpretation of SPECT, PET and CT images. Finally, two main sessions have been formatted using a “debate-style” presentation, which provides the audience with both sides of a key issue.” 

ICNC8’s calendar of events:

JJB: “The ICNC programme committee is, as we speak, actively working on the programme for ICNC8. The advisory board and organisational committee are working on logistical issues concerning the meeting in Prague.
One other activity, separate from ICNC, is worth mentioning. Europe has the tendency to integrate NC more and the new European Council Nuclear on Cardiology (ECNC), composed of 10 members, an EANM and ESC joint initiative, is working actively on this trend.”

RH: “We are pleased that the Programme Committee has now completed its task of generating a first draft of the programme. Of course, minor changes will occur, but the content is now established. The advisory committee will continue to provide input for the meeting and help to promote its importance throughout the world. Finally, the organising committee is still very active in planning many aspects for ICNC8 including social and culture events such as the Gala dinner, which will be held on Tuesday, 1 May 2007.
Over the course of the next several months, our abstract submission services will open, then the process of grading these abstracts and planning oral and poster sessions will follow. Immediately afterward, special invitations will be sent to the selected presenters.”
 

Why ICNC is a not-to-miss congress:

JJB: “We believe that there is a strong need for this meeting. The differences in the utilisation of NC in the US, Europe and Asia is striking. The ICNC meeting permits integration of NC throughout the world; the international meeting is important in terms of communication, networking, learning about new technologies etc.
Globally the programme of ICNC8 will be composed of a half US and half European faculty. In addition, the input from Asia is become extremely important. The aim is to include top speakers from Asia on the faculty. The audience is also composed of 50% US and 50% European attendees, but the attendance of Asia, in particular Japan, is growing rapidly and extremely important for the success of the meeting.
In particular, NC is performed at high standards in the Asian countries, both clinical and research wise.”

“ICNC really provides an important and unique forum for international nuclear cardiologists. The meeting is crucial for maintaining personal communication and interaction between scientists and clinicians involved in nuclear cardiology. The meeting furthermore offers outstanding continuing medical education, opportunities to present and discuss research, and to establish and maintain a sharing system between the international scientific and clinical communities. The ICNC meeting should be continued for years to come. “

RH: “During my Presidency of the American Society of Nuclear Cardiology, my key focus was the expansion of nuclear cardiology, including the globalisation of this imaging method. Through conferences such as ICNC, this is clearly a reality. ICNC is the largest meeting of its kind and has an excellent reputation. Now, with its first meeting outside of Western Europe, ICNC will hopefully reach new audiences and continue to emphasise the worldwide importance of nuclear cardiology."

References

JEROEN JOOST BAX, MD, PHD
Born : 1966, Amsterdam, NL
Place of work:University Hospital Leiden, the Netherlands;
Current work: Professor Cardiology,
Director non-invasive imaging,
Leiden University Hospital, the Netherlands.
Current roles: Chair ESC working group nuclear Cardiology Chair Dutch working group Nuclear Cardiology and MRI Board of directors Am Soc Nuclear Cardiology Chair CPC ESC 2007-2008.

ROBERT HENDEL, MD
Born: 1955, New Haven, Connecticut USA;
Place of work:Midwest Heart Specialists, Fox River Grove, Illinois, USA;
Current work: Professor of Medicine, Rush University Medical Center Chicago, Illinois, USA Clinical Cardiologist, Midwest Heart Specialists.
Current roles: Executive Council and Board of Directors, American Society of Nuclear Cardiology (ASNC) Past-President, ASNC
Organizing Committee, ASNC 2006 Annual Meeting Co-Chairman, Appropriateness Criteria Working Group, American College of Cardiology Member, Coalition of ardiovascular Organizations, ACC Steering Committee, Quality in cardiovascular imaging symposium, ACC.