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Cardiovascular Imaging in Global Health Radiology

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Abstract

Cardiovascular disease (CVD) is the number one cause of death globally, and morbidity and mortality are highest in low- and middle-income countries (LMICs) due to unavailability and unaffordability of medical resources for diagnosis and management of CVD. This has led to disastrous economic consequences on the individual, household, and societal level in these regions. Cardiovascular imaging is essential to the care of patients with CVD; however, access to cardiovascular imaging is very limited in low- and middle-income countries due to expense of equipment and challenges in training healthcare personnel to correctly order, acquire, and interpret studies. The state-of-the-art tools for cardiac imaging include echocardiography, coronary angiography and left ventriculography, nuclear imaging, cardiac computed tomography, and cardiac magnetic resonance imaging. Of the available cardiac imaging modalities, echo is the most widely used in LMICs because it is safe, portable, relatively inexpensive, and able to diagnose a variety of CVDs. Additionally, inexperienced practitioners can be trained to perform a focused cardiovascular exam by echo, for example, in screening for rheumatic heart disease, in a relatively short period. Handheld or pocket-sized echo machines are particularly useful, and the images can be interpreted locally or uploaded for remote interpretation by expert cardiologists. Instituting the infrastructure for cardiovascular imaging alone is not sufficient. Clinicians in LMICs must be trained to properly refer patients and interpret the results. Additionally, patients must have access to and be able to afford necessary medicines and surgeries for treatment of CVDs. In the future, the gap to CVD treatment in LMICs may be closed further by use of telemedicine and mobile cardiovascular imaging tools as well as continued international efforts to lower infrastructure costs and train local providers in its use.

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Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

AIDS:

Acquired immunodeficiency disease syndrome

CACS:

Coronary artery calcium scores

CAD:

Coronary artery disease

CCTA:

Cardiac computed tomography angiography

CHD:

Congenital heart disease

CMR:

Cardiac magnetic resonance

CT:

Computed tomography

CVD:

Cardiovascular disease

EBCT:

Electron-beam computed tomography

GDP:

Gross domestic product

HCU:

Hand-carried cardiac ultrasound

HF:

Heart failure

HIV:

Human immunodeficiency virus

IAEA:

International Atomic and Energy Agency

IV:

Intravenous

LMICs:

Low- and middle-income countries

LV:

Left ventricle

MDCT:

Multi-detector computed tomography

MPI:

Myocardial perfusion imaging

NCD:

Noncommunicable disease

NGO:

Nongovernmental organization

PCU:

Pocket-sized ultrasound

RHD:

Rheumatic heart disease

RP:

Radiation protection

SPECT:

Single-photon emission computed tomography

TEE:

Transesophageal echo

TTE:

Transthoracic echo

USA:

United States

WHO:

World Health Organization

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Authors and Affiliations

  1. Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA

    Katherine C. Michelis & David L. Narotsky

  2. Department of Medicine, George Washington University, Washington, DC, USA

    Brian G. Choi

Authors
  1. Katherine C. Michelis
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  2. David L. Narotsky
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  3. Brian G. Choi
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Correspondence to Brian G. Choi .

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Editors and Affiliations

  1. RAD-AID International, Chevy Chase, MD, USA

    Daniel J. Mollura

  2. RAD-AID International, Chevy Chase, MD, USA

    Melissa P. Culp

  3. Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA

    Matthew P. Lungren

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Michelis, K.C., Narotsky, D.L., Choi, B.G. (2019). Cardiovascular Imaging in Global Health Radiology. In: Mollura, D., Culp, M., Lungren, M. (eds) Radiology in Global Health. Springer, Cham. https://doi.org/10.1007/978-3-319-98485-8_17

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  • DOI: https://doi.org/10.1007/978-3-319-98485-8_17

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