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Cardiovascular Imaging in Global Health Radiology

  • Katherine C. Michelis
  • David L. Narotsky
  • Brian G. ChoiEmail author
Chapter

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.

Keywords

Low- and middle-income countries Cardiovascular imaging Telemedicine Echocardiography Ultrasound 

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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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Katherine C. Michelis
    • 1
  • David L. Narotsky
    • 1
  • Brian G. Choi
    • 2
    Email author
  1. 1.Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular InstituteNew YorkUSA
  2. 2.Department of MedicineGeorge Washington UniversityWashington, DCUSA

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