Evicore Cardiac Imaging Guidelines
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Medical Policy
bmchp.org | 888-566-0008 wellsense.org | 877-957-1300 Medical Policy Ambulatory Cardiac Monitors (Excluding Holter Monitors) Policy Number: OCA 3.35 Version Number: 24 Version Effective Date: 03/01/21 + Product Applicability All Plan Products Well Sense Health Plan Boston Medical Center HealthNet Plan Well Sense Health Plan MassHealth Qualified Health Plans/ConnectorCare/Employer Choice Direct Senior Care Options ◊ Notes: + Disclaimer and audit information is located at the end of this document. ◊ The guidelines included in this Plan policy are applicable to members enrolled in Senior Care Options only if there are no criteria established for the specified service in a Centers for Medicare & Medicaid Services (CMS) national coverage determination (NCD) or local coverage determination (LCD) on the date of the prior authorization request. Review the member’s product-specific benefit documents at www.SeniorsGetMore.org to determine coverage guidelines for Senior Care Options. Policy Summary The Plan considers the use of ambulatory cardiac monitors in the outpatient setting to be medically necessary if the type of ambulatory cardiac monitor is covered for the Plan member and ALL applicable Plan criteria are met, as specified in the Medial Policy Statement and Limitations sections of this policy. Plan prior authorization is required. When the device is covered for the member, medically necessary ambulatory cardiac monitors utilized in the outpatient setting may include ambulatory cardiac event monitors, mobile cardiac outpatient telemetry, and/or single-use external ambulatory electrocardiographic monitoring patches available by prescription. Ambulatory Cardiac Monitors (Excluding Holter Monitors) + Plan refers to Boston Medical Center Health Plan, Inc. and its affiliates and subsidiaries offering health coverage plans to enrolled members. -
Index2 Rev.Pdf
INDEX A American Association of Thoracic Surgery, 19 Abiomed total artificial heart, 197 American College of Cardiology, 69 ACE inhibitors, 118 Amosov, Nikolay, 30–31 adenovirus, 199 anasarca, 63 Agnew Clinic, The, 16 anastomosis, 222 Akutsu, Dr. Tetsuzo, 186, 189 aneurysms alcohol aortic, 223–225 blood lipids, relationship between, catheter treatment, 225 53–54 challenges, surgical, 224 breast cancer link, 55 diagnosis, 224 consumption, 51, 53–54 discovery, 223 dangers, 55 dissection, 226–227 French Paradox, 52 stent treatment, 225 life expectancy, 56 stent-graft treatment, 225–226, mortality rates, 55 231–232 pattern of consumption, 54 surgical treatment, 230 red wine consumption, 54 symptoms, 223 scientific data summary, 55 types, 223–225 wine drinker profile vs. beer drinker angina pectoris, 42, 159 profile, 54 classic symptoms, 60 alpha-linoleic acid, 49 signaling impending heart attack, 61 alveoli, 35 angiogenesis, 199 ambulatory electrocardiogram monitoring, angiography, coronary, 86 74 angiography, pulmonary, 86 284 INDEX antibiotic protection, dental surgery, 57 arterial blood samples, 81 anticoagulant use, 134 arterial oxygen levels, 81 aorta, 32, 38, 96 arterial revascularization, 241 aortic arch, 103 arterial system, 221 aortic incompetence, 159 artery, definition, 33 aortic valve, 35, 64 artherosclerosis, 45 aortic valve disease, 158–159 artificial heart, 186 aortic valve incompetence, 159–160 Akutsu, Dr. Tetsuzo, 186 aortic valve stenosis, 64, 158–159 Clark, Barney, 188 aortomyoplasty Cooley, Dr. Denton, 186 advantages, 193 DeBakey, Dr. Michael, 186 application, 193 development, 186 definition, 192 DeVries, Dr. William, 188 Arbulu, Dr. Agustin, 163 first implantation, 186 argyria, 66 flaws, 200 arrhythmia, 64, 74 Jarvik, Dr. Robert, 188 advancements in studies, 217 Jarvik-7, 187–188 atrial, 140 Jarvik-2000, 201 atrial fibrillation, 215, 218 Kolff, Dr. -
Ambulatory Event Monitors
Corporate Medical Policy Ambulatory Event Monitors File Name: a mbulatory_event_monitors Origination: 10/2000 Last CAP Review: 10/2020 Next CAP Review: 10/2021 Last Review: 10/2020 Description of Procedure or Service Various devices are available for outpatient cardiac rhythm monitoring. These devices differ in the types of monitoring leads used, the duration and continuity of monitoring, the ability to detect arrhythmias without patient intervention, and the mechanism of delivery of the information from pa tient to clinicia n. These devices may be used to evaluate symptoms suggestive of arrhythmias (eg, syncope, palpitations), and may be used to detect atrial fibrillation (AF) in patients who have undergone cardiac ablation of AF or who have a history of cryptogenic stroke. Ca rdiac monitoring is routinely used in the inpatient setting to detect acute changes in heart rate or rhythm that may need urgent response. For some clinical conditions, a more prolonged period of monitoring in the ambulatory setting is needed to detect heart rate or rhythm abnormalities that may occur infrequently. These cases may include the diagnosis of arrhythmias in patients with signs and symptoms suggestive of a rrhythmias, as well a s, the evaluation of paroxysmal a tria l fibrilla tion (AF). Arrhythmia Detection in Patients With Signs/Symptoms of Arrhythmia Ca rdiac a rrhythmias may be suspected because of symptoms suggestive of a rrhythmias, including palpitations, dizziness, or syncope or presyncope, or because of abnormal heart rate or rhythm noted on exam. A full discussion of the differential diagnosis and evaluation of each of these symptoms is beyond the scope of this review, but some general principles on the use of ambulatory monitoring are discussed. -
Physiological Assessment of Coronary Lesions
CHAPTER 5 Physiological Assessment of Coronary Lesions Akl C. Fahed, MD, MPH1 and Sammy Elmariah, MD, MPH1 1Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Cardiology, Department of Medicine Introduction The treatment of symptomatic coronary artery disease (CAD) depends on the hemodynamic impairment of flow, a physiologic parameter that is not captured with coronary angiography alone. The miniaturization of sensor-guidewires capable of crossing coronary stenoses provided a rationale for physiological assessment of coronary lesions to guide coronary revascularization. Multiple clinical trials have demonstrated the superiority of using invasive physiologic assessment to guide decision-making in intermediate vessel stenosis over angiography alone. 1,2 Current guidelines give a class IA recommendation for use invasive physiological assessment to guide revascularization of angiographically intermediate lesions in patients with stable angina. 3,4 Coronary physiology measurement has therefore become routine practice in every cardiac catherization lab with expanding techniques and indications. This chapter will cover the basic physiologic principles of coronary blood flow, technical aspects of coronary physiology measurements, and the expanding clinical data supporting the use of coronary physiology measurement in every day practice. Understanding Coronary Blood Flow Myocardial blood flow provides oxygen supply in an effort to meet the myocardial oxygen demand (MVO2) and prevent ischemia or infarction. The main determinants of myocardial oxygen demand and supply are highlighted in Table 1. In a healthy coronary and capillary circuit, blood flows from the aorta though an epicardial conduit, then precapillary arterioles and the microvascular capillary bed in a highly regulated process (Figure 1). The resistance (pressure/flow) across the circuit is the sum of the resistances within the circuit: the epicardial coronaries (R epicardial), the precapillary arterioles (R arteriolar), and the microvascular capillary bed (R capillary). -
Impaired Cardiac Autonomic Nervous Control After Cardiac Bypass Surgery for Congenital Heart Disease૾૾૾
Impaired cardiac autonomic nervous control after cardiac bypass surgery for congenital heart disease૾૾૾, Laura McGlonea, *, Neil Patelbc , David Young , Mark D. Danton b aPrincess Royal Maternity Hospital, Alexandra Parade, Glasgow, Scotland, UK bThe Royal Hospital for Sick Children, Yorkhill, Glasgow, UK cDepartment of Medical Statistics, University of Strathclyde, Glasgow, UK Abstract We undertook a study to describe changes in heart rate variability (HRV) postoperatively in children undergoing cardiac bypass surgery for congenital heart disease (CHD). HRV was recorded for a 1-h period preoperatively and a 24-h period postoperatively in 20 children with CHD. We found a highly significant reduction in HRV in both time and frequency domain indices compared to preoperative values, which was sustained throughout the 24-h study period. There was a negative correlation between both time and frequency domain HRV measurements and length of cardiac bypass. HRV is reduced postoperatively and correlates with cardiac bypass time. Length of cardiac bypass time may be one mechanism whereby HRV is reduced following surgery. Keywords: Cardiopulmonary bypass; Congenital; Autonomic nervous system; Heart rate 1. Introduction pacemaker, or if they required cardiac pacing postopera- tively. Approval was obtained from the Local Ethics Com- ( ) Heart rate variability HRV is a measure of cardiac mittee prior to study commencement and informed autonomic nervous control. In adult patients, reductions in parental consent was obtained for all participants. HRV are independent predictors of mortality in congestive heart failure and after myocardial infarction w1–3x. In children with congenital heart disease (CHD),HRVis 2.1. HRV recording reduced compared to normal controls and is predictive of HRV was recorded for 1 h preoperatively (24–48 h prior w x sudden cardiac death 1 . -
ST-Elevation Myocardial Infarction Due to Acute Thrombosis in an Adolescent with COVID-19
Prepublication Release ST-Elevation Myocardial Infarction Due to Acute Thrombosis in an Adolescent With COVID-19 Jessica Persson, MD, Michael Shorofsky, MD, Ryan Leahy, MD, MS, Richard Friesen, MD, Amber Khanna, MD, MS, Lyndsey Cole, MD, John S. Kim, MD, MS DOI: 10.1542/peds.2020-049793 Journal: Pediatrics Article Type: Case Report Citation: Persson J, Shorofsky M, Leahy R, et al. ST-elevation myocardial infarction due to acute thrombosis in an adolescent with COVID-19. Pediatrics. 2021; doi: 10.1542/peds.2020- 049793 This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version. Downloaded from©202 www.aappublications.org/news1 American Academy by of guest Pediatrics on September 27, 2021 Prepublication Release ST-Elevation Myocardial Infarction Due to Acute Thrombosis in an Adolescent With COVID-19 Jessica Persson, MD1, Michael Shorofsky, MD1, Ryan Leahy, MD, MS1, Richard Friesen, MD1, Amber Khanna, MD, MS1,2, Lyndsey Cole, MD3, John S. Kim, MD, MS1 1Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado 2Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado 3Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado Corresponding Author: John S. -
Citric Acid Cycle Metabolites Predict Infarct Size in Pigs Submitted To
International Journal of Molecular Sciences Article Citric Acid Cycle Metabolites Predict Infarct Size in Pigs Submitted to Transient Coronary Artery Occlusion and Treated with Succinate Dehydrogenase Inhibitors or Remote Ischemic Perconditioning Marta Consegal 1,2,3, Norberto Núñez 4, Ignasi Barba 1,2,3,5 , Begoña Benito 1,2,3, Marisol Ruiz-Meana 1,2,3, Javier Inserte 1,2,3 , Ignacio Ferreira-González 1,2,6,* and Antonio Rodríguez-Sinovas 1,2,3,* 1 Cardiovascular Diseases Research Group, Department of Cardiology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; [email protected] (M.C.); [email protected] (I.B.); [email protected] (B.B.); [email protected] (M.R.-M.); [email protected] (J.I.) 2 Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain 3 Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain 4 Unit of High Technology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; [email protected] Citation: Consegal, M.; Núñez, N.; 5 Faculty of Medicine, University of Vic-Central University of Catalonia (UVicUCC), Can Baumann. Ctra. de Barba, I.; Benito, B.; Ruiz-Meana, M.; Roda, 70, 08500 Vic, Spain Inserte, J.; Ferreira-González, I.; 6 Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública (CIBERESP), Rodríguez-Sinovas, A. -
Clinical Effect of Selective Interventional Therapy on Sub-Acute
Wang et al. Eur J Med Res (2018) 23:27 https://doi.org/10.1186/s40001-018-0319-8 European Journal of Medical Research RESEARCH Open Access Clinical efect of selective interventional therapy on sub‑acute ST‑segment elevation myocardial infarction under the guidance of fractional fow reserve and coronary arteriography Bing‑Jian Wang1, Jin Geng1, Qian‑Jun Li1, Ting‑Ting Hu1, Biao Xu2 and Shu‑Ren Ma1* Abstract Objective: This study aims to compare the clinical efects of selective interventional therapy (PCI) under the guid‑ ance of fractional fow reserve (FFR) and coronary arteriography. Methods: Patients with sub-acute ST-segment elevation myocardial infarction (sub-acute STEMI), who were under selective PCI treatment between April 2012 and June 2014, were included into this study. These patients were divided into two groups, based on FFR measurements: FFR-PCI group and radiography-PCI group. Then, diferences in clinical symptoms, coronary angiography, intervention, and endpoint events were compared between these two groups. Results: A total of 592 patients with sub-acute STEMI were included in this study (207 patients in the FFR-PCI group and 385 patients in the radiography-PCI group). No statistical diferences were observed in baseline clinical data and coronary angiography results between these two groups. Mean stent number was greater in the radiography-PCI group (1.22 0.32) than in the FFR-PCI group (1.10 0.29), and the diference was statistically signifcant (P 0.019). During the follow± -up period, 78 adverse events occurred± (21 adverse events in the FFR-PCI group and 57 adverse= events in the radiography-PCI group); and no statistical signifcance was observed between these two groups (log- rank P 0.112). -
Detection of Myocardial Ischemia Due to Clinically Asymptomatic Coronary
Journal of Electrocardiology 59 (2020) 100–105 Contents lists available at ScienceDirect Journal of Electrocardiology journal homepage: www.jecgonline.com Detection of myocardial ischemia due to clinically asymptomatic coronary artery stenosis at rest using supervised artificial intelligence- enabled vectorcardiography – A five-fold cross validation of accuracy☆ Till Braun a, Sotirios Spiliopoulos b, Charlotte Veltman a, Vera Hergesell b, Alexander Passow a,c, Gero Tenderich a,c, Martin Borggrefe d, Michael M. Koerner e,f,⁎ a Cardisio GmbH, The Squaire 12, D-60549 Frankfurt am Main, Germany b Department of Cardiac Surgery, University Heart Center Graz, Medical University Graz, Auenbruggerplatz 29, A-8036 Graz, Austria c Faculty of Medicine, University Bochum, Universitaetsstrasse 150, D-44801 Bochum, Germany d First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (Ger- man Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany e Nazih Zuhdi Advanced Cardiac Care & Transplant Institute, Department of Medicine, Integris Baptist Medical Center, 3400 NW Expressway, Bldg C, Suite 300, Oklahoma City, OK 73162, USA f Department of Rural Health - Medicine/Cardiology, Oklahoma State University Center For Health Sciences, 1111 W 17th Street, Tulsa, OK 74107, USA article info abstract Background: Coronary artery disease (CAD) is a leading cause of death and disability. Conventional non-invasive Keywords: diagnostic modalities for the detection of stable CAD at rest are subject to significant limitations: low sensitivity, Cardisiography and personal expertise. We aimed to develop a reliable and time-cost efficient screening tool for the detection of Coronary artery disease coronary ischemia using machine learning. -
Cardiostat™ – Compared to a Standard ECG Holter Monitoring
Journal of Electrocardiology 53 (2019) 57–63 Contents lists available at ScienceDirect Journal of Electrocardiology journal homepage: www.jecgonline.com Validation of a novel single lead ambulatory ECG monitor – Cardiostat™ – Compared to a standard ECG Holter monitoring Isabelle Nault ⁎,1, Philippe André 1,BenoitPlourde1,FrançoisLeclerc1, Jean-François Sarrazin 1, François Philippon 1, Gilles O'Hara 1,FranckMolin1, Christian Steinberg 1,KarineRoy1, Louis Blier 1, Jean Champagne 1 IUCPQ – Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada article info abstract Keywords: Background: Cardiostat™ is a single lead ambulatory ECG monitor. Recording is made through 2 electrodes posi- Ambulatory ECG monitoring tioned in a lead 1-like configuration. We first validated its accuracy for atrial fibrillation detection compared to a fi Atrial brillation 12-lead ECG. In the second phase of the study, arrhythmia detection accuracy was compared between Extended monitoring Cardiostat™ ambulatory ECG and a standard 24 h Holter ECG monitoring. Method/results: Phase one of the study included patients undergoing cardioversion for atrial fibrillation (AF) or atrial flutter. Cardiostat™ tracings were compared with standard 12-lead ECG. In the second phase, patients undergoing 24 h ambulatory Holter ECG monitoring for control or suspicion of atrial fibrillation (AF) were included. Simultaneous Holter monitoring and Cardiostat™ ECG recordings were per- formed. Tracings were analysed and compared. Two hundred twelve monitoring were compared. AF was diagnosed in 73 patients. Agreement between Cardiostat™ ECG and standard Holter monitoring was 99% for AF detection with kappa = 0.99. Kappa correlation for atrial flutter detection was only moderate at 0.51. AF burden was similar in both recordings. -
Cocaine and the Heart
Thomas Jefferson University Jefferson Digital Commons Division of Cardiology Faculty Papers Division of Cardiology 5-1-2010 Cocaine and the heart. Suraj Maraj Albert Einstein Medical Center, Department of Cardiovascular Diseases, Philadelphia, PA Vincent M. Figueredo, M.D. Thomas Jefferson University D Lynn Morris Albert Einstein Medical Center, Department of Cardiovascular Diseases, Philadelphia, PA Follow this and additional works at: https://jdc.jefferson.edu/cardiologyfp Part of the Cardiology Commons Let us know how access to this document benefits ouy Recommended Citation Maraj, Suraj; Figueredo, M.D., Vincent M.; and Lynn Morris, D, "Cocaine and the heart." (2010). Division of Cardiology Faculty Papers. Paper 16. https://jdc.jefferson.edu/cardiologyfp/16 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Division of Cardiology Faculty Papers by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. As submitted to: Clinical Cardiology And later published as: Cocaine and the Heart Volume 33, Issue 5, May 2010, Pages 264-269 DOI: 10.1002/clc.20746 Suraj Maraj, MD, Vincent M. Figueredo, MD, D Lynn Morris, MD Introduction Cocaine is currently the second most commonly used illicit drug in the United States, with marijuana usage being the commonest (1). -
Medical Policy Cardiac Event Monitors
Medical Policy Cardiac Event Monitors Subject: Cardiac Event Monitors Background: Cardiac arrhythmias are abnormal heart rhythms that can cause palpitations, weakness, dizziness, fainting, blood clots, or death. There are a wide variety of treatments available for arrhythmias, however, obtaining an accurate diagnosis can be difficult since arrhythmias can occur infrequently and unpredictably and may not cause obvious symptoms. Remote cardiac monitoring technologies allow home electrocardiographic (EKG) monitoring of individuals with suspected cardiac arrhythmias or at risk for developing arrhythmias. A variety of ambulatory external EKG monitoring systems have been developed. These include 24– 48-hour Holter monitoring, 7–14-day patch-type monitoring, self-activated event monitors, and auto-triggered loop monitors. To detect infrequent arrhythmias, members can undergo 24 to 48 hours of continuous outpatient EKG recording with a Holter monitor. A limitation of this device is that repeated monitoring sessions may be necessary if an arrhythmia does not occur during the first 1 or 2 days. Another method for detection of infrequent arrhythmias is the use of an event recorder, which stores 1 to 2 minutes of EKG data as soon as the individual experiences symptoms and presses a button to activate the device. Although this technique enables a much longer period of monitoring, some arrhythmias do not cause obvious symptoms and some symptomatic members fail to turn on the recorder at the right time. The following are descriptions of various cardiac event monitors: • Cardiac event detection monitoring (implantable loop monitoring): An implantable loop recorder (ILR) is rarely the preferred initial test for ambulatory ECG monitoring (AECG). However, this test can be useful for members with infrequent (e.g.