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JOURNAL OF NUCLEAR CARDIOLOGY ASNC UPDATE ASNC NEWS President’s Message: Advances in Cardiovascular Medicine Cardiovascular medicine has advanced dramatically in the past 35 years, substantially reducing the mortality rate from both heart and cerebrovascular disease. Since 1970, the US age-adjusted heart disease mortality rate has decreased by an average of 2.5% per year (Figure 1).1 Analogous results have been observed in numerous other countries.2 In the last 3 years in which US data are available, 2002 to 2003 and 2003 to 2004, the pace of decline accelerated to 3.5% and 6.5%, respectively.3,4 Examining the period from 1970 to 2000, Lenfant5 found that US life expectancy increased by 6 years, attributing two thirds of this improvement to fewer deaths from cardiac and cerebrovascular disease. My suggestions for the leading milestones in heart disease care since 1970 are listed in Table 1. Taking the early 1970s as an example, key advances included the initial publications on the development of electrophysiologic testing by Wellens et al6 in 1972, as well as the commencement of the National High Blood Pressure Education Program by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in that same year7; the use of exercise stress perfusion imaging by Zaret et al8 in 1973; and the use of -blockers in congestive heart failure patients by Waagstein et al9 in 1975. Medical discoveries and their dissemination have stimulated improvements in hygienic measures as well over the last 3 ½ decades. For example, the US diet has improved, with a decreasing percentage of the diet consumed as saturated fat and cholesterol and a consequent decrease in average US serum cholesterol levels.10 Much of this change was stimulated by the National Cholesterol Education Program implemented in 1985.10 Despite the relatively abrupt nature of each discovery, the improvement in cardiac outcomes has been surprisingly J Nucl Cardiol 2007;14:136-8. 1071-3581/$32.00 Copyright © 2007 by the American Society of Nuclear Cardiology. doi:10.1016/j.nuclcard.2006.12.316 136
Figure 1. Age-standardized mortality rates for heart disease (International Classification of Diseases, Ninth Revision codes 390-398, 402, 404, and 410-429), cancer (140-208, 238.6), and stroke (cerebrovascular disease) (430-438) from 1970 through 2004. Rates are age-adjusted to the 2000 US standard population. The figure has been updated to include age-standardized mortality rates for 2003 and 2004 from references 3 and 4. (Adapted with permission from Jemal et al.1)
gradual and steady. For example, when statins became available in 1986, the 2.5% decrease had already been taking place for more than a decade, and the rate—though it continued— did not accelerate. The most likely explanation for this annual decrease is that each milestone— be it therapeutic with angioplasty, -blockers, or angiotensinconverting enzyme inhibitors; population-based with risk factor reduction; or diagnostic with myocardial perfusion imaging (MPI) or stress echocardiography—provided an incremental improvement in care resulting in the ongoing reduction in cardiac mortality rate. Cardiac imaging has played a critical role in driving this trend. Those who created and enhanced MPI and the “imaging cardiologists” who implement the technique have had an extraordinary impact on our patients, our communities, and our countries. In the United States payors have challenged us that imaging is overused.11,12 It behooves physicians and payors, however, to reflect upon the impact that imaging has had on the health and literally the survival of our patients. It would be difficult to imagine the care of those with congestive heart failure or endocarditis without echocardiography, or the manJournal of Nuclear Cardiology January/February 2007
Journal of Nuclear Cardiology Volume 14, Number 1;136-8
News update
Table 1. Milestones in cardiac care from 1970 to 2006
Year of publication, performance, or release 1972 1972 1973 1975 1976 1977 1977 1978 1978 1979 1980 1980 1981 1982 1982 1983 1984
1984 1985 1986 1986 1988 1986 1990 1991 1991 1996 1996 1996 1998 2002 2003
Milestones Electrophysiologic testing6 National High Blood Pressure Program7 Exercise MPI8 -Blockers in congestive heart failure9 Transesophageal echocardiography15 Thallium 201 released in United States Coronary angioplasty16 Propranolol released in United States Pharmacologic stress MPI17 Stress echocardiography18 Automatic internal cardiac defibrillator19 Cardiac magnetic resonance imaging20 Angiotensin-converting enzyme inhibitors released in United States Over-the-wire coronary angioplasty21 His bundle catheter ablation22 Color Doppler echocardiography23 American College of Cardiology/American Heart Association clinical guidelines24 -Blockers for acute MI25 National Cholesterol Education Program10 Coronary stenting performed26,27 Lovastatin released in United States Aspirin for MI28 Intravenous streptokinase for MI29 Primary balloon angioplasty for MI30,31 Cardiac technetium 99m radioisotopes released in United States Gated single photon emission computed tomography32 Tissue plasminogen activator for MI released in United States Atrial fibrillation ablation33 Carotid stenting34 Biventricular pacing35 16-Slice cardiac computed tomography36 Drug-eluting coronary stents released in United States
MI, Myocardial infarction.
137
agement of coronary artery disease without MPI as a diagnostic and prognostic tool. In 2005, an estimated 9.3 million patients underwent single photon emission computed tomography perfusion imaging in the United States.13 Rather than reflecting overuse, I suggest that its popularity represents the degree to which cardiologists rely on MPI in the initial and longitudinal care of their patients. With this momentum and adequate funding for research and development, advances will continue for decades to come, and nuclear cardiology will not be left out. The iodine-123 agents beta-methyliodophenyl-pentadecanoic acid and metaiodobenzylguanidine are in late phase 3 trials as ischemic and sympathetic tone markers, respectively.14 The selective adenosine A2a receptor agonists are even further along. New fluorine-18 positron emission tomography perfusion radiotracers are in active development. The integration of a new anatomic study, computed tomography coronary angiography, with the physiologic evaluation of coronary artery disease by MPI, shows much promise. Continued improvements such as these presage a continued 2.5% decrease in the cardiac mortality rate resulting in cardiac disease dropping below cancer as the number one cause of death in the United States in approximately 2013, a remarkable achievement of cardiac care. Acknowledgment I offer great thanks to Nanette Musgrave and Tamara Fraley for their expert research assistance and Daniel B. Kramer, MD for his skilled editorial efforts.
Gregory S. Thomas, MD, MPH President References 1. Jemal A, Ward E, Hao Y, Thun M. Trends in the leading causes of death in the United States, 1970-2002. JAMA 2005;294:1255-9. 2. Wilson D, McLellan MS. Lifestyle factors and the prevention movement. Available from: URL: www.pitt.edu/⬃super1/lecture/ lec4091/006.htm Accessed November 20, 2005. 3. Hoyert DL, Heron M, Murphy SL, Kung H-C. Deaths: Final Data for 2003. Centers for Disease Control and Prevention Web site. Available from: URL: http://www.cdc.gov/nchs/data/hestat/ finaldeaths03_tables.pdf. Accessed September 4, 2006. 4. Miniño AM, Heron M, Murphy SL, Kochanek KD. Deaths: Final Data for 2004. Centers for Disease Control and Prevention Web site. Available from: URL: http://www.cdc.gov/nchs/data/hestat/ preliminarydeaths04_tables.pdf#1. Accessed September 30, 2006. 5. Lenfant C. Shattuck lecture— clinical research to clinical practice— lost in the translation. N Engl J Med 2003;349:868-73. 6. Wellens HJJ, Schuilenburg RM, Durrer D. Electrical stimulation of the heart in patients with ventricular tachycardia. Circulation 1972;46:216-26.
138
News update
Journal of Nuclear Cardiology January/February 2007
7. National High Blood Pressure Education Program. Program description. Available from: URL: http://www.nhlbi.nih.gov/about/ nhbpep/nhbp_pd.htm Accessed November 20, 2006. 8. Zaret BL, Strauss HW, Martin ND, Wells HP Jr, Flamm MD. Noninvasive regional myocardial perfusion with radioactive potassium: study of patients at rest, with exercise and during angina pectoris. N Engl J Med 1973;288:809-12. 9. Waagstein F, Hjalmarson A, Varnaskas E, Wallentin I. Effect of chronic beta-adrenergic receptor blockade. Br Heart J 1975;37: 1022-36. 10. Cleeman J, Lenfant C. National Cholesterol Education Program: progress and prospects. JAMA 1998;280:2099-104. 11. Report to the Congress: Medicare payment policy. Washington, DC: Medicare Payment Advisory Commission; 2005. 12. Bateman TB, Thomas GS. High-quality nuclear cardiology imaging services in office-based practice. J Nucl Cardiol 2004;11:245-52. 13. Nuclear medicine census market summary report. Des Plaines (IL): IMV Medical Information Division; 2006. 14. Gerson M. President’s message: the promise of I-123 radiotracers. J Nucl Cardiol 2006;13:302-8. 15. Frazin L, Talono JV, Stephanides L, Loeb HS, Koppel L, Gunnar RM. Esophageal echocardiography. Circulation 1976;54:102-8. 16. Gruentzig AR. Transluminal dilation of coronary artery stenosis [letter]. Lancet 1978;263:1. 17. Gould KL, Westcout RJ, Albro PC, Hamilton GW. Noninvasive assessment of coronary stenoses by myocardial imaging during vasodilation II. Clinical methodology and feasibility. Am J Cardiol 1978;41:279-87. 18. Wann LS, Faris JC, Childress RC, Dillon JC, Weyman AE, Feigenbaum H. Exercise cross-sectional echocardiography in ischemic heart disease. Circulation 1979;60:1300-7. 19. Mirowski M, Reid PR, Mower MM, et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator. N Engl J Med 1980;303:322-5. 20. Goldman MR, Pohost GM, Ingwall JS, Fossel ET. Nuclear magnetic resonance imaging: potential cardiac applications. Am J Cardiol 1980;46:1278-83. 21. Simpson JB, Baim DS, Robert EW, Harrison DC. A new catheter system for coronary angioplasty. Am J Cardiol 1982;49:1216-22. 22. Gallagher JJ, Svenson RH, Kasell JH, et al. Catheter technique for closed chest ablation of the atrioventricular conduction system. N Engl J Med 1982;306:194-200. 23. Omoto R, Yokote Y, Takamoto S, et al. Clinical significance of newly-developed real-time intracardiac two-dimensional blood flow imaging system (2-D Doppler) [abstract]. Jpn Circ J 1983; 47:974.
24. Frye RL, Collins JJ, DeSanctis RW, Dodge HT, Dreifus LS, Fisch C, et al. Guidelines for permanent cardiac pacemaker implantation, May 1984. A report of the Joint American College of Cardiology/ American Heart Association Task Force on Assessment of Cardiovascular Procedures (Subcommittee on Pacemaker Implantation). Circulation 1984;70:331A-339A. 25. Reduction in infarct size with the early use of timolol in acute myocardial infarction. N Engl J Med 1984;310:9-15. 26. Siegwart U, Mirkovitch V, Joffre F, Kappenberg L. Intravascular stents to prevent reocclusion and restenosis after transluminal angioplasty. N Engl J Med 1987;316:701-6. 27. Mehta MJ, Kahn IA. Cardiology’s ten greatest discoveries of the 20th century. Tex Heart Inst J 2002;29:164-71. 28. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988;2:349-60. 29. Gruppo Italiano Per Lo Studio Della Streptochinasi Nell’Infarct Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986;1:397402. 30. Hartzler GO, Rutherford BD, McConahay DR, Johnson WL, McCallister BD, Gura GM, et al. Percutaneous transluminal coronary angioplasty with and without thrombolytic therapy for treatment of acute myocardial infarction. Am Heart J 1983;106: 965-73. 31. Angioplasty in the Treatment of Heart Attack. Interview with Geoffrey Hartzler, MD. Available from: http://www.ptca.org/ videos.html. Accessed November 19, 2006. 32. Mochizuki T, Murase K, Fujiwara Y, Itoh T, Miyagawa M, Tanada S, et al. ECG-gated thallium-201 myocardial SPECT in patients with old myocardial infarction compared with ECG-gated blood pool SPECT. Ann Nucl Med 1991;5:47-51. 33. Shaw DC, Haissaguerre M, Jais P. Catheter ablation of pulmonary vein foci for atrial fibrillation. Thorac Cardiovasc Surg 1999; 47(Suppl 3):352-6. 34. Theron JG, Payelle GG, Coshun O, Huet HF, Guimareaus L. Carotid artery stenosis: treatment with protected balloon angioplasty and stent placement. Radiology 1996;201:627-36. 35. Daubert JC, Ritter P, Le Breton H, et al. Permanent left ventricular pacing with transvenous leads inserted into the coronary veins. Pacing Clin Electrophysiol 1998;21:239-45. 36. Nieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PM, de Feyter PJ. Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 2002;106:2051-4.
CALENDAR CALENDAR Please note that the programs listed below are sponsored or cosponsored by the American Society of Nuclear Cardiology (ASNC). For more information, visit the ASNC Web site (http://www.asnc.org/education/ calendar.cfm). March 8-10 and 11-13, 2007. Hands-On Training: Cardiac CT and CT Angiography. Chicago, Ill.
March 23, 2007. Nuclear Cardiology: Overview and Update. An Educational Session for Fellows and Newto-Practice Physicians. New Orleans, La. April 12-14, 2007. CT Angiography for the Cardiologist. Chicago, Ill. April 29-May 2, 2007. Eighth International Conference of Nuclear Cardiology (ICNC 8). Prague, Czech Republic. May 5-6, 2007. Nuclear Cardiology for the Technologist. Chicago, Ill.
Figure 1. Age-standardized mortality rates for heart disease (International Classification of Diseases, Ninth Revision codes 390-398, 402, 404, and 410-429), cancer (140-208, 238.6), and stroke (cerebrovascular disease) (430-438) from 1970 through 2004. Rates are age-adjusted to the 2000 US standard population. The figure has been updated to include age-standardized mortality rates for 2003 and 2004 from references 3 and 4. (Adapted with permission from Jemal et al.1)
gradual and steady. For example, when statins became available in 1986, the 2.5% decrease had already been taking place for more than a decade, and the rate—though it continued— did not accelerate. The most likely explanation for this annual decrease is that each milestone— be it therapeutic with angioplasty, -blockers, or angiotensinconverting enzyme inhibitors; population-based with risk factor reduction; or diagnostic with myocardial perfusion imaging (MPI) or stress echocardiography—provided an incremental improvement in care resulting in the ongoing reduction in cardiac mortality rate. Cardiac imaging has played a critical role in driving this trend. Those who created and enhanced MPI and the “imaging cardiologists” who implement the technique have had an extraordinary impact on our patients, our communities, and our countries. In the United States payors have challenged us that imaging is overused.11,12 It behooves physicians and payors, however, to reflect upon the impact that imaging has had on the health and literally the survival of our patients. It would be difficult to imagine the care of those with congestive heart failure or endocarditis without echocardiography, or the manJournal of Nuclear Cardiology January/February 2007
Journal of Nuclear Cardiology Volume 14, Number 1;136-8
News update
Table 1. Milestones in cardiac care from 1970 to 2006
Year of publication, performance, or release 1972 1972 1973 1975 1976 1977 1977 1978 1978 1979 1980 1980 1981 1982 1982 1983 1984
1984 1985 1986 1986 1988 1986 1990 1991 1991 1996 1996 1996 1998 2002 2003
Milestones Electrophysiologic testing6 National High Blood Pressure Program7 Exercise MPI8 -Blockers in congestive heart failure9 Transesophageal echocardiography15 Thallium 201 released in United States Coronary angioplasty16 Propranolol released in United States Pharmacologic stress MPI17 Stress echocardiography18 Automatic internal cardiac defibrillator19 Cardiac magnetic resonance imaging20 Angiotensin-converting enzyme inhibitors released in United States Over-the-wire coronary angioplasty21 His bundle catheter ablation22 Color Doppler echocardiography23 American College of Cardiology/American Heart Association clinical guidelines24 -Blockers for acute MI25 National Cholesterol Education Program10 Coronary stenting performed26,27 Lovastatin released in United States Aspirin for MI28 Intravenous streptokinase for MI29 Primary balloon angioplasty for MI30,31 Cardiac technetium 99m radioisotopes released in United States Gated single photon emission computed tomography32 Tissue plasminogen activator for MI released in United States Atrial fibrillation ablation33 Carotid stenting34 Biventricular pacing35 16-Slice cardiac computed tomography36 Drug-eluting coronary stents released in United States
MI, Myocardial infarction.
137
agement of coronary artery disease without MPI as a diagnostic and prognostic tool. In 2005, an estimated 9.3 million patients underwent single photon emission computed tomography perfusion imaging in the United States.13 Rather than reflecting overuse, I suggest that its popularity represents the degree to which cardiologists rely on MPI in the initial and longitudinal care of their patients. With this momentum and adequate funding for research and development, advances will continue for decades to come, and nuclear cardiology will not be left out. The iodine-123 agents beta-methyliodophenyl-pentadecanoic acid and metaiodobenzylguanidine are in late phase 3 trials as ischemic and sympathetic tone markers, respectively.14 The selective adenosine A2a receptor agonists are even further along. New fluorine-18 positron emission tomography perfusion radiotracers are in active development. The integration of a new anatomic study, computed tomography coronary angiography, with the physiologic evaluation of coronary artery disease by MPI, shows much promise. Continued improvements such as these presage a continued 2.5% decrease in the cardiac mortality rate resulting in cardiac disease dropping below cancer as the number one cause of death in the United States in approximately 2013, a remarkable achievement of cardiac care. Acknowledgment I offer great thanks to Nanette Musgrave and Tamara Fraley for their expert research assistance and Daniel B. Kramer, MD for his skilled editorial efforts.
Gregory S. Thomas, MD, MPH President References 1. Jemal A, Ward E, Hao Y, Thun M. Trends in the leading causes of death in the United States, 1970-2002. JAMA 2005;294:1255-9. 2. Wilson D, McLellan MS. Lifestyle factors and the prevention movement. Available from: URL: www.pitt.edu/⬃super1/lecture/ lec4091/006.htm Accessed November 20, 2005. 3. Hoyert DL, Heron M, Murphy SL, Kung H-C. Deaths: Final Data for 2003. Centers for Disease Control and Prevention Web site. Available from: URL: http://www.cdc.gov/nchs/data/hestat/ finaldeaths03_tables.pdf. Accessed September 4, 2006. 4. Miniño AM, Heron M, Murphy SL, Kochanek KD. Deaths: Final Data for 2004. Centers for Disease Control and Prevention Web site. Available from: URL: http://www.cdc.gov/nchs/data/hestat/ preliminarydeaths04_tables.pdf#1. Accessed September 30, 2006. 5. Lenfant C. Shattuck lecture— clinical research to clinical practice— lost in the translation. N Engl J Med 2003;349:868-73. 6. Wellens HJJ, Schuilenburg RM, Durrer D. Electrical stimulation of the heart in patients with ventricular tachycardia. Circulation 1972;46:216-26.
138
News update
Journal of Nuclear Cardiology January/February 2007
7. National High Blood Pressure Education Program. Program description. Available from: URL: http://www.nhlbi.nih.gov/about/ nhbpep/nhbp_pd.htm Accessed November 20, 2006. 8. Zaret BL, Strauss HW, Martin ND, Wells HP Jr, Flamm MD. Noninvasive regional myocardial perfusion with radioactive potassium: study of patients at rest, with exercise and during angina pectoris. N Engl J Med 1973;288:809-12. 9. Waagstein F, Hjalmarson A, Varnaskas E, Wallentin I. Effect of chronic beta-adrenergic receptor blockade. Br Heart J 1975;37: 1022-36. 10. Cleeman J, Lenfant C. National Cholesterol Education Program: progress and prospects. JAMA 1998;280:2099-104. 11. Report to the Congress: Medicare payment policy. Washington, DC: Medicare Payment Advisory Commission; 2005. 12. Bateman TB, Thomas GS. High-quality nuclear cardiology imaging services in office-based practice. J Nucl Cardiol 2004;11:245-52. 13. Nuclear medicine census market summary report. Des Plaines (IL): IMV Medical Information Division; 2006. 14. Gerson M. President’s message: the promise of I-123 radiotracers. J Nucl Cardiol 2006;13:302-8. 15. Frazin L, Talono JV, Stephanides L, Loeb HS, Koppel L, Gunnar RM. Esophageal echocardiography. Circulation 1976;54:102-8. 16. Gruentzig AR. Transluminal dilation of coronary artery stenosis [letter]. Lancet 1978;263:1. 17. Gould KL, Westcout RJ, Albro PC, Hamilton GW. Noninvasive assessment of coronary stenoses by myocardial imaging during vasodilation II. Clinical methodology and feasibility. Am J Cardiol 1978;41:279-87. 18. Wann LS, Faris JC, Childress RC, Dillon JC, Weyman AE, Feigenbaum H. Exercise cross-sectional echocardiography in ischemic heart disease. Circulation 1979;60:1300-7. 19. Mirowski M, Reid PR, Mower MM, et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator. N Engl J Med 1980;303:322-5. 20. Goldman MR, Pohost GM, Ingwall JS, Fossel ET. Nuclear magnetic resonance imaging: potential cardiac applications. Am J Cardiol 1980;46:1278-83. 21. Simpson JB, Baim DS, Robert EW, Harrison DC. A new catheter system for coronary angioplasty. Am J Cardiol 1982;49:1216-22. 22. Gallagher JJ, Svenson RH, Kasell JH, et al. Catheter technique for closed chest ablation of the atrioventricular conduction system. N Engl J Med 1982;306:194-200. 23. Omoto R, Yokote Y, Takamoto S, et al. Clinical significance of newly-developed real-time intracardiac two-dimensional blood flow imaging system (2-D Doppler) [abstract]. Jpn Circ J 1983; 47:974.
24. Frye RL, Collins JJ, DeSanctis RW, Dodge HT, Dreifus LS, Fisch C, et al. Guidelines for permanent cardiac pacemaker implantation, May 1984. A report of the Joint American College of Cardiology/ American Heart Association Task Force on Assessment of Cardiovascular Procedures (Subcommittee on Pacemaker Implantation). Circulation 1984;70:331A-339A. 25. Reduction in infarct size with the early use of timolol in acute myocardial infarction. N Engl J Med 1984;310:9-15. 26. Siegwart U, Mirkovitch V, Joffre F, Kappenberg L. Intravascular stents to prevent reocclusion and restenosis after transluminal angioplasty. N Engl J Med 1987;316:701-6. 27. Mehta MJ, Kahn IA. Cardiology’s ten greatest discoveries of the 20th century. Tex Heart Inst J 2002;29:164-71. 28. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988;2:349-60. 29. Gruppo Italiano Per Lo Studio Della Streptochinasi Nell’Infarct Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986;1:397402. 30. Hartzler GO, Rutherford BD, McConahay DR, Johnson WL, McCallister BD, Gura GM, et al. Percutaneous transluminal coronary angioplasty with and without thrombolytic therapy for treatment of acute myocardial infarction. Am Heart J 1983;106: 965-73. 31. Angioplasty in the Treatment of Heart Attack. Interview with Geoffrey Hartzler, MD. Available from: http://www.ptca.org/ videos.html. Accessed November 19, 2006. 32. Mochizuki T, Murase K, Fujiwara Y, Itoh T, Miyagawa M, Tanada S, et al. ECG-gated thallium-201 myocardial SPECT in patients with old myocardial infarction compared with ECG-gated blood pool SPECT. Ann Nucl Med 1991;5:47-51. 33. Shaw DC, Haissaguerre M, Jais P. Catheter ablation of pulmonary vein foci for atrial fibrillation. Thorac Cardiovasc Surg 1999; 47(Suppl 3):352-6. 34. Theron JG, Payelle GG, Coshun O, Huet HF, Guimareaus L. Carotid artery stenosis: treatment with protected balloon angioplasty and stent placement. Radiology 1996;201:627-36. 35. Daubert JC, Ritter P, Le Breton H, et al. Permanent left ventricular pacing with transvenous leads inserted into the coronary veins. Pacing Clin Electrophysiol 1998;21:239-45. 36. Nieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PM, de Feyter PJ. Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 2002;106:2051-4.
CALENDAR CALENDAR Please note that the programs listed below are sponsored or cosponsored by the American Society of Nuclear Cardiology (ASNC). For more information, visit the ASNC Web site (http://www.asnc.org/education/ calendar.cfm). March 8-10 and 11-13, 2007. Hands-On Training: Cardiac CT and CT Angiography. Chicago, Ill.
March 23, 2007. Nuclear Cardiology: Overview and Update. An Educational Session for Fellows and Newto-Practice Physicians. New Orleans, La. April 12-14, 2007. CT Angiography for the Cardiologist. Chicago, Ill. April 29-May 2, 2007. Eighth International Conference of Nuclear Cardiology (ICNC 8). Prague, Czech Republic. May 5-6, 2007. Nuclear Cardiology for the Technologist. Chicago, Ill.