Michael Hadley

@hadleymd.bsky.social

System Director, Advanced Cardiac Imaging, Northwell Health not medical advice; views are my own; retweets are not endorsements

CCTA isn’t just for diagnosis, it’s a PCI playbook. Excellent new review details how #CCTA offers shorter cases, less contrast/radiation, fewer geographic misses, better stent sizing, and a reproducible workflow you can teach.

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❗ Coronary calcium scoring is a great way to risk stratify patients for the #1 cause of death, but many insurance plans still don't cover this test. 👏 Here's a new expert statement in @JACCJournals that calls on payers to provide coverage. The time is now for progress. buff.ly/UCWJZG5

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🔥 Hot off the press! 2025 CV Imaging Training Statement 🛣️ New "Advanced Imager" pathway with Level II-like competence in CT, MR, Echo, and Nuc 🚀 Nice emphasis on cross-modality integration for CAD, sarcoid, amyloid, HCM pericardium, masses, structural, and ACHD Link below👇

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💥 Myocardial Blood Flow (#MBF) isn't just a #PET thing anymore. #CCT and #CMR are in the game. 🚦 Angina isn't always explained by epicardial stenoses. Quantification of MBF can detect other causes (#ANOCA), like microvascular disease, HCM, or transplant vasculopathy.

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🤔 Thought-provoking piece in @CircAHA from Kole & Joshi 🫀 A growing group of patients with subclinical atherosclerosis falls in between traditional "primary" and "secondary" prevention. I've heard of "prevention 1.5" or "plaque-informed prevention." How about the following classification system?👇

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💥 Just out in #JACC CVI: State-of-the-Art on Photon-Counting CT 👇 Why this technology is a game-changer: ☢️ Better for patients: ⬇️ radiation and ⬇️ contrast 😅 Better for readers: spatial rez of 0.1mm + ⬇️ blooming = stents and calcified plaques are clearer than ever before

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💥 As coronary CTA volumes increase, we must keep radiation exposures as low as reasonably achievable. ☢️ AHA/ACC/SCCT recommend a goal of median CCTA dose ≤4 mSv, which has been achieved in multicenter trials without compromising quality.

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💥 Photon-counting detector CT offers good diagnostic accuracy for detecting ISR, overcoming artifacts that have plagued prior generations of scanners. 🔬 In a blinded study of 283 stented lesions, PCD-CT, as compared to cath, demonstrated NPV of 96.4% and accuracy of 88.9% for ISR ≥50%.

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💫 #CMR is useful for predicting SCD in NICM. 📊 DERIVATE 2.0 provides better risk classification, incorporating gender, LVEF, and amount/location of #LGE. 👉 Let's look beyond LVEF alone to determine which NICM patients get ICD. Full text: doi.org/10.1093/ehjc... #CMR @SCMR #cardiosky

Redefining the risk of major arrhythmic events in non-ischaemic cardiomyopathy: insights from the DERIVATE-NICM study

AbstractAims. Selection of the patients for implantable cardioverter defibrillator primary prevention therapy in non-ischaemic cardiomyopathy (NICM) needs

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🚨 Preventing first heart attacks may need a rethink. 🔬 In this massive study of 4.6 million people with their first heart attack: --18% had no standard modifiable risk factors --51% had no warning symptoms beforehand --63% weren't on preventive meds (only 22% on statin)

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💥 The SCOT-HEART 2 trail could transform how we identify those at risk of heart attacks. 🔬 Trial randomizes asymptomatic patients ages 40-70 with ≥1 risk factors to either #CoronaryCTA or standard care, with appropriate therapies, looking for primary outcome of heart attack.

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❓As Plaque Analysis roles out nationwide for #CCTA, providers are asking "How will this change clinical management?" ✔️The DECIDE registry provides one framework: Total Plaque Volume determines level of therapy. 🔬More research is needed to show impact on hard outcomes. #cardiotwitter @NorthwellHealth

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