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Coronary Artery Disease: HELP
Articles by S. Bruce Greenberg
Based on 2 articles published since 2009
(Why 2 articles?)
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Between 2009 and 2019, S. Bruce Greenberg wrote the following 2 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline ACR Appropriateness Criteria 2017

Anonymous3940905 / Akers, Scott R / Panchal, Vandan / Ho, Vincent B / Beache, Garth M / Brown, Richard K J / Ghoshhajra, Brian B / Greenberg, S Bruce / Hsu, Joe Y / Kicska, Gregory A / Min, James K / Stillman, Arthur E / Stojanovska, Jadranka / Abbara, Suhny / Jacobs, Jill E. ·Principal Author, VA Medical Center, Philadelphia, Pennsylvania. Electronic address: akerssco@me.com. · Research Author, Internal Medicine Resident, Henry Ford Allegiance Health, Jackson, Michigan. · Panel Vice-Chair, Uniformed Services University of the Health Sciences, Bethesda, Maryland. · University of Louisville School of Medicine, Louisville, Kentucky. · University Hospital, Ann Arbor, Michigan. · Massachusetts General Hospital, Boston, Massachusetts. · Arkansas Children's Hospital, Little Rock, Arkansas. · Kaiser Permanente, Los Angeles, California. · University of Washington, Seattle, Washington. · Cedars Sinai Medical Center, Los Angeles, California; American College of Cardiology. · Emory University Hospital, Atlanta, Georgia. · University of Michigan Health System, Ann Arbor, Michigan. · Specialty Chair, UT Southwestern Medical Center, Dallas, Texas. · Panel Chair, New York University Medical Center, New York, New York. ·J Am Coll Radiol · Pubmed #28473096.

ABSTRACT: In patients with chronic chest pain in the setting of high probability of coronary artery disease (CAD), imaging has major and diverse roles. First, imaging is valuable in determining and documenting the presence, extent, and severity of myocardial ischemia, hibernation, scarring, and/or the presence, site, and severity of obstructive coronary lesions. Second, imaging findings are important in determining the course of management of patients with suspected chronic myocardial ischemia and better defining those patients best suited for medical therapy, angioplasty/stenting, or surgery. Third, imaging is also necessary to determine the long-term prognosis and likely benefit from various therapeutic options by evaluating ventricular function, diastolic relaxation, and end-systolic volume. Imaging studies are also required to demonstrate other abnormalities, such as congenital/acquired coronary anomalies and severe left ventricular hypertrophy, that can produce angina in the absence of symptomatic coronary obstructive disease due to atherosclerosis. Clinical risk assessment is necessary to determine the pretest probability of CAD. Multiple methods are available to categorize patients as low, medium, or high risk for developing CAD. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

2 Review ACR Appropriateness Criteria Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease. 2015

Hoffmann, Udo / Akers, Scott R / Brown, Richard K J / Cummings, Kristopher W / Cury, Ricardo C / Greenberg, S Bruce / Ho, Vincent B / Hsu, Joe Y / Min, James K / Panchal, Kalpesh K / Stillman, Arthur E / Woodard, Pamela K / Jacobs, Jill E. ·Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: uhoffmann@partners.org. · VA Medical Center, Philadelphia, Pennsylvania. · University Hospital, Ann Arbor, Michigan. · Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri. · Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida. · Arkansas Children's Hospital, Little Rock, Arkansas. · Uniformed Services University of the Health Sciences, Bethesda, Maryland. · Diagnostic Imaging, Los Angeles, California. · Cedars Sinai Medical Center, Los Angeles, California, American College of Cardiology. · University of Cincinnati Hospital, Cincinnati, Ohio. · Emory University Hospital, Atlanta, Georgia. · New York University Medical Center, New York, New York. ·J Am Coll Radiol · Pubmed #26653833.

ABSTRACT: Primary imaging options in patients at low risk for coronary artery disease (CAD) who present with undifferentiated chest pain and without signs of ischemia are functional testing with exercise or pharmacologic stress-based electrocardiography, echocardiography, or myocardial perfusion imaging to exclude myocardial ischemia after rule-out of myocardial infarction and early cardiac CT because of its high negative predictive value to exclude CAD. Although possible, is not conclusive whether triple-rule-out CT (CAD, pulmonary embolism, and aortic dissection) might improve the efficiency of patient management. More advanced noninvasive tests such as cardiac MRI and invasive imaging with transesophageal echocardiography or coronary angiography are rarely indicated. With increased likelihood of noncardiac causes, a number of diagnostic tests, among them ultrasound of the abdomen, MR angiography of the aorta with or without contrast, x-ray rib views, x-ray barium swallow, and upper gastrointestinal series, can also be appropriate. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. This recommendation is based on excellent evidence, including several randomized comparative effectiveness trials and blinded observational cohort studies.