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Cardiac Imaging Guidelines Effective October 1, 2021
Cigna Medical Coverage Policies – Radiology Cardiac Imaging Guidelines Effective October 1, 2021 ____________________________________________________________________________________ Instructions for use The following coverage policy applies to health benefit plans administered by Cigna. Coverage policies are intended to provide guidance in interpreting certain standard Cigna benefit plans and are used by medical directors and other health care professionals in making medical necessity and other coverage determinations. Please note the terms of a customer’s particular benefit plan document may differ significantly from the standard benefit plans upon which these coverage policies are based. For example, a customer’s benefit plan document may contain a specific exclusion related to a topic addressed in a coverage policy. In the event of a conflict, a customer’s benefit plan document always supersedes the information in the coverage policy. In the absence of federal or state coverage mandates, benefits are ultimately determined by the terms of the applicable benefit plan document. Coverage determinations in each specific instance require consideration of: 1. The terms of the applicable benefit plan document in effect on the date of service 2. Any applicable laws and regulations 3. Any relevant collateral source materials including coverage policies 4. The specific facts of the particular situation Coverage policies relate exclusively to the administration of health benefit plans. Coverage policies are not recommendations for treatment and should never be used as treatment guidelines. This evidence-based medical coverage policy has been developed by eviCore, Inc. Some information in this coverage policyy m na ot apply to all benefit plans administered by Cigna. These guidelines include procedures eviCore does not review for Cigna. -
National Taiwan University Hospital Hsinchu Branch Research Protocol 2018
National Taiwan University Hospital Hsinchu Branch Research Protocol 2018 1. Project name Prevalence and Outcomes of Peripheral Artery Disease in Sepsis Patients in the Medical Title Intensive Care Unit Principal Department of Internal Medicine, Cardiovascular Division investigator Mu-Yang Hsieh, Attending Physician Table of Contents 1. Project name.........................................................................................................................................................1 2. Abstract................................................................................................................................................................3 Background...............................................................................................................................................................3 Methods....................................................................................................................................................................3 3. Background..........................................................................................................................................................4 Prior research in this field.........................................................................................................................................4 Sepsis and peripheral artery disease..............................................................................................................4 Peripheral artery disease- its impact on the outcomes..................................................................................4 -
Disentangling the Multiple Links Between Renal Dysfunction and Cerebrovascular Disease Dearbhla Kelly, Peter Malcolm Rothwell
Cerebrovascular disease J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp-2019-320526 on 11 September 2019. Downloaded from REVIEW Disentangling the multiple links between renal dysfunction and cerebrovascular disease Dearbhla Kelly, Peter Malcolm Rothwell ► Additional material is ABSTRact consequences of renal dysfunction,and diseases that published online only. To view, Chronic kidney disease (CKD) has a rapidly rising can cause both CKD and stroke. please visit the journal online (http:// dx. doi. org/ 10. 1136/ global prevalence, affecting as many as one-third jnnp- 2019- 320526). of the population over the age of 75 years. CKD is ASSOciatiONS BETWEEN CKD AND a well-known risk factor for cardiovascular disease CEREBROVASCULAR DISEASE Centre for the Prevention and, in particular, there is a strong association with Stroke risk of Stroke and Dementia, stroke. Cohort studies and trials indicate that reduced Nuffield Department of Clinical There is conflicting evidence about whether CKD, Neurosciences, University of glomerular filtration rate increases the risk of stroke by specifically low estimated glomerular filtration Oxford, Oxford, UK about 40% and that proteinuria increases the risk by rate (eGFR), is a risk factor for stroke indepen- about 70%. In addition, CKD is also strongly associated dent of traditional cardiovascular risk factors. In Correspondence to with subclinical cerebrovascular abnormalities, vascular a meta-analysis of 22 634 people from four popu- Dr Dearbhla Kelly, Centre for cognitive impairment and -
Peripheral Vascular Disease (PVD) Fact Sheet
FACT SHEET FOR PATIENTS AND FAMILIES Peripheral Vascular Disease (PVD) What is peripheral vascular disease? Vascular disease is disease of the blood vessels (arteries and veins). Peripheral vascular disease (PVD) affects The heart receives blood, the areas that are “peripheral,” or outside your heart. sends it to The most common types of PVD are: the lungs to get oxygen, • Carotid artery disease affects the arteries and pumps that carry blood to your brain. It occurs when it back out. one or more arteries are narrowed or blocked by plaque, a fatty substance that builds up inside artery walls. Carotid artery disease can increase Veins carry Arteries carry your risk of stroke. It can also cause transient blood to your oxygen-rich [TRANZ-ee-ent] ischemic [iss-KEE-mik] attacks (TIAs). heart to pick blood from up oxygen. your heart TIAs are temporary changes in brain function to the rest of that are sometimes called “mini-strokes.” your body. • Peripheral arterial disease (PAD) often affects the arteries to your legs and feet. It is also caused by Healthy blood vessels provide oxygen plaque buildup, and can for every part of your body. cause pain that feels like a dull cramp or heavy tiredness in your hips or legs when • Venous insufficiency affects the veins, usually you exercise or climb stairs. in your legs or feet. Your veins have valves that This pain is sometimes Damaged Healthy keepvalve blood fromvalve flowing backward as it moves called claudication. If PAD toward your heart. If the valves stop working, blood worsens, it can cause cold Plaque can build backs up in your body, usually in your legs. -
Cardiovascular Disease Session Guidelines
Cardiovascular Disease Session Guidelines This is a 15 minute webinar session for CNC physicians and staff CNC holds webinars on the 3rd Wednesday of each month to address topics related to risk adjustment documentation and coding Next scheduled webinar: • Wednesday, February 28th • Topic: Respiratory Disease CNC does not accept responsibility or liability for any adverse outcome from this training for any reason including undetected inaccuracy, opinion, and analysis that might prove erroneous or amended, or the coder/physician’s misunderstanding or misapplication of topics. Application of the information in this training does not imply or guarantee claims payment. Agenda • Statistics • Amputation Status & Atherosclerosis • Angina Pectoris • Acute Myocardial Infarction • Specified Heart Arrhythmias • Congestive Heart Failure • Pulmonary Hypertension • Cardiomyopathy • Hypertensive Heart disease Statistics • Nearly 35 percent of Tarrant County and Dallas area deaths each year are attributed to cardiovascular disease. • About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths • Heart disease is the leading cause of death for both men and women • Every year about 735,000 Americans have a heart attack. Of these, (approximately 70%) 525,000 are a first heart attack and (approximately 30%)210,000 happen in people who have already had a heart attack Amputations There are nearly 2 million people living with limb loss in the United States Approximately 185,000 amputations occur in the United States each -
Vascular Disease in the Elderly
Chapter 13: Vascular Disease in the Elderly Nobuyuki Bill Miyawaki* and Paula E. Lester† *Division of Nephrology and †Division of Geriatrics, Winthrop University Hospital, Mineola, New York PHYSIOLOGIC EFFECTS OF AGING ON stiffening of medium and large arteries lined with BLOOD VESSEL ELASTICITY AND atheromatous plaques. The progressive accumula- COMPLIANCE tion of atherosclerotic plaque continues with aging and often remains silent until lesions reach a critical The aging process is commonly associated with in- stenotic threshold or rupture, leading to dimin- creased vascular rigidity and decreased vascular ished organ perfusion. Arterial stiffening also leads compliance. This process reflects the accumulation to an increase in pulse wave velocity and an en- of smooth muscle cells and connective tissue in the hancement in central aortic systolic pressure.3 The walls of major blood vessels. Endothelial cells and increased waveform velocity allows the backward smooth muscle cells constitute most of vessel wall reflective wave to return earlier back to the heart. cellularity and the remainder of the wall is com- The resulting increases of the left ventricular myo- posed of extracellular matrix including collagen cardial load and the loss of coronary perfusion at and elastin. Although aging has minimal effect on the onset of diastole may potentiate myocardial the muscular tunica media layer thickness, aging ischemia.3 leads to profound progressive thickening of the tu- Common ailments in the elderly including dia- nica intima layer comprised -
Rivaroxaban for High-Risk Patients with Stable Coronary Artery Disease: NICE Recommendation by Montasir Ali and Nadir Elamin
Available online at www.bcs.com ‘Promoting excellence in cardiovascular care’ BCS Editorial Rivaroxaban for high-risk Take Home Messages patients with stable coronary • Patients with stable coronary artery disease artery disease: NICE remain a challenge to treat as they remain at recommendation increased risk of further cardiovascular events. • NICE have recently recommended the combined Montasir H Alia MBBS, MRCP, PGCert use of low dose Rivaroxaban and Aspirin to prevent Nadir Elaminb MBBS, MRCP atherothrombotic events in patients with stable coronary artery disease or in patients with aCore Medical Trainee, bSpecialist Registrar in Cardiology symptomatic peripheral artery disease at high risk of Northern General Hospital ischemic events. Sheffield, United Kingdom • Clinicians may take time to apply the new Editor Deputy Editor Gershan Davis Ahmed Adlan recommendation, particularly in primary care. 18th February 2020 Introduction Rivaroxaban as an additional treatment option to Aspirin alone for high-risk patients with stable Rivaroxaban is a direct oral anticoagulant (DOAC) cardiovascular disease (CVD) to prevent recurrent that works as a direct factor Xa inhibitor. thrombotic events.2 Traditionally, Rivaroxaban has been used to reduce the risk of stroke and systemic embolization in patients with nonvalvular atrial fibrillation (AF) and Secondary prevention in established in the treatment of deep vein thrombosis and cardiovascular disease pulmonary embolism. Cardiovascular diseases continue to cause a major In a large recent randomised -
Structural Heart Disease Interventions: Rapid Clinical Growth and Challenges in Image Guidance
Investigations and research Structural heart disease interventions: rapid clinical growth and challenges in image guidance J.D. Carroll University of Colorado, Department of Medicine, Division of Cardiology, S.J. Chen Colorado, USA. M.S. Kim A.R. Hansgen A. Neubauer Philips Research, Briarcliff Manor, New York, USA. University of Colorado, Department of Medicine, Division of Cardiology, Colorado, USA. O. Wink Philips Healthcare, Bothell, Washington, USA. University of Colorado, Department of Medicine, Division of Cardiology, Colorado, USA. Structural heart disease (SHD) interventions modification of anatomical structure and represent a broad category of percutaneous function, using balloon dilatation and tissue treatments for patients with both congenital ablation, to the deployment of various plugs, heart disease (CHD) and acquired heart disease valves, clips and cinching devices (Table 1). involving structural and functional abnormalities of heart valves, cardiac chambers The current status of SHD interventions ranges and the proximal great vessels [1, 2]. In the last from well-established procedures, such as five years, there has been an explosion in the percutaneous balloon valvuloplasty for stenotic number of innovative approaches to these valve conditions, which has been incorporated catheter-based treatments, ranging from the into clinical practice guidelines as the preferred Time period of Percutaneous SHD interventions Image guidance modality F emerging into Table 1. The development of practice structural heart disease (SHD) interventions. -
Intensive Care Medicine
Intensive Care Medicine WHAT’S NEW IN INTENSIVE CARE Un-edited accepted proof Facing COVID-19 in ICU: vascular dysfunction, thrombosis, and dysregulated inflammation Daniel E. Leisman MD,1 Clifford S. Deutschman MD, MS, MCCM,2 and Matthieu Legrand MD, PhD3 1 Icahn School of Medicine at Mount Sinai, New York, New York 2. Departments of Pediatrics, Molecular Medicine and Surgery, Cohen Children’s Medical Center, Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York 3. Department of Anesthesiology and Peri-Operative Medicine and Critical Care Medicine, University of California, San Francisco, California. This article has undergone peer-review and has been accepted for publication in the Journal Intensive Care Medicine (ICM). This is not yet the definitive version of the manuscript as it will undergo copyediting and typesetting before it is published in its final form with a DOI. DOI: 10.1007/s00134-020-06059-6 Corresponding author: Matthieu Legrand, Department of Anesthesiology and Perioperative Care, University of California, San Francisco, United States. e-mail address: [email protected] Leisman DE et al. Facing COVID-19 in ICU: vascular dysfunction, thrombosis, and dysregulated inflammation. Intensive Care Medicine (2020); DOI: 10.1007/s00134-020-06059-6 Intensive Care Medicine WHAT’S NEW IN INTENSIVE CARE Un-edited accepted proof Current management guidelines for COVID-19 reflect the assumption that critically ill patients infected with SARS-CoV-2 develop acute respiratory distress syndrome (ARDS). However, emerging data and clinical reports increasingly suggest an alternative view that severe COVID-19 reflects a confluence of vascular dysfunction, thrombosis, and dysregulated inflammation. -
Deep Vein Thrombosis (DVT)
Deep Vein Thrombosis (DVT) What is Deep Vein Thrombosis (DVT)? Common Signs and Symptoms of PE Deep vein thrombosis, commonly referred to as “DVT,” occurs PE can be fatal, if you experience these signs or symptoms when a blood clot or thrombus, develops in the large veins seek medical attention right away. of the legs or pelvic area. Some DVTs may cause no pain, whereas others can be quite painful. With prompt diagnosis and • Shortness of breath treatment, the majority of DVT’s are not life threatening. How- • Sudden chest pain ever, a blood clot that forms in the invisible “deep veins” can be life threatening. A clot that forms in the large, deep veins is • A feeling of apprehension more likely to break free and travel through the vein. It is then • Sudden collapse called an embolus. When an embolus travels from the legs or • Coughing pelvic areas and lodges in a lung artery, the condition is known as a “pulmonary embolism,” or PE, a potentially fatal condition • Sweating if not immediatelyfighting diagnosed VASCULAR and treated. DISEASE...improving• BloodyVASCULAR phlegm (coughingHEALTH up blood) Symptoms The signs and symptoms of these disorders (DVT and PE) Approximately one-half of those with a DVT never have recog- can vary by individual and event. Some individuals may nizable symptoms. The most common symptom is leg pain and also experience uncommon symptoms such as dizziness, tenderness in the calf muscles. One may also observe swelling back pain or wheezing. or a change in color of one leg to purple or blue. These signs and symptoms may appear suddenly or may steadily develop Diagnosis over a short period of time. -
![[18F]-Sodium Fluoride Autoradiography Imaging of Nephrocalcinosis In](https://docslib.b-cdn.net/cover/1083/18f-sodium-fluoride-autoradiography-imaging-of-nephrocalcinosis-in-3601083.webp)
[18F]-Sodium Fluoride Autoradiography Imaging of Nephrocalcinosis In
www.nature.com/scientificreports OPEN [18F]‑sodium fuoride autoradiography imaging of nephrocalcinosis in donor kidneys and explanted kidney allografts Stan Benjamens 1,2*, Ines F. Antunes2, Jan‑Luuk Hillebrands3, Melanie Reijrink4, Marian L. C. Bulthuis3, Stefan P. Berger5, Cyril Moers1, Martin H. de Borst5, Riemer H. J. A. Slart2,6 & Robert A. Pol1 Nephrocalcinosis is present in up to 43% of kidney allograft biopsies at one‑year after transplantation and is associated with inferior graft function and poor graft survival. We studied [18F]‑sodium fuoride ([18F]‑NaF) imaging of microcalcifcations in donor kidneys (n = 7) and explanted kidney allografts (n = 13). Three µm parafn‑embedded serial sections were used for histological evaluation of calcifcation (Alizarin Red; Von Kossa staining) and ex‑vivo [18F]‑NaF autoradiography. The images were fused to evaluate if microcalcifcation areas corresponded with [18F]‑NaF uptake areas. Based on histological analyses, tubulointerstitial and glomerular microcalcifcations were present in 19/20 and 7/20 samples, respectively. Using autoradiography, [18F]‑NaF uptake was found in 19/20 samples, with signifcantly more tracer activity in kidney allograft compared to deceased donor kidney samples (p = 0.019). Alizarin Red staining of active microcalcifcations demonstrated good correlation (Spearman’s rho of 0.81, p < 0.001) and Von Kossa staining of consolidated calcifcations demonstrated signifcant but weak correlation (0.62, p = 0.003) with [18F]‑NaF activity. This correlation between ex‑vivo [18F]‑NaF uptake and histology‑proven microcalcifcations, is the frst step towards an imaging method to identify microcalcifcations in active nephrocalcinosis. This may lead to better understanding of the etiology of microcalcifcations and its impact on kidney transplant function. -
Review Da Costa's Syndrome Or Neurocirculatory Asthenia
Br Heart J 1987;58:306-15 Review Da Costa's syndrome or neurocirculatory asthenia OGLESBY PAUL From the Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA SUMMARY The syndrome variously called Da Costa's syndrome, effort syndrome, neuro- circulatory asthenia, etc has been studied for more than 100 years by many distinguished physi- cians. Originally identified in men in wartime, it has been widely recognised as a common chronic condition in both sexes in civilian life. Although the symptoms may seem to appear after infec- tions and various physical and psychological stresses, neurocirculatory asthenia is most often encountered as a familial disorder that is unrelated to these factors, although they may aggravate an existing tendency. Respiratory complaints (including breathlessness, with and without effort, and smothering sensations) are almost universal, and palpitation, chest discomfort, dizziness and faintness, and fatigue are common. The physical examination is normal. The aetiology is obscure but patients usually have a normal life span. Reassurance and measures to improve physical fitness are helpful. Da Costa's syndrome or neurocirculatory asthenia Although Jacob M Da Costa is the name most has a long and honourable history in the medical honoured by history in this condition, at least one literature and in clinical medicine. Yet it is infre- other relevant report antedated his paper in 1871. quently mentioned today. It is unlikely to have dis- On 3 June 1863 Dr Henry Hartshorne made a appeared; it probably exists much as before but is presentation regarding heart disease in the Union more often identified and labelled in psychiatric Army to the College of Physicians in Philadelphia.