Download Analysis of Imaging Modalities Used for Coronary Artery Disease in

International Conference on Integrated Medical Imaging in Cardiovascular
Diseases (IMIC 2016)
Contribution ID : 8
Type : poster
Analysis of Imaging Modalities Used for Coronary Artery
Disease in Sri Lanka and Identification of Challenges
Abstract content
Background: Diagnosis and management of coronary artery disease (CAD) is a major challenge
to health care in Sri Lanka as in many other countries. Coronary artery disease accounts for
40-45% adult deaths in Sri Lanka and incidence appears to be rising. Until recently, the main
diagnostic technique for CAD was invasive coronary angiography(CA). Nowadays, cardiologists
prefer to perform non invasive modalities such as echocardiography, cardiac CT, myocardial perfusion
SPECT(MPS), and cardiac MRI. In this study we critically evaluate current practice of these imaging
modalities in Sri Lanka.
Methodology: The study period was from 01-01-2015 to 30-12-2015. Data from all patients referred to
and registered at the Ischemic Heart Disease Unit of the National Hospital of Sri Lanka was obtained
for the study. Details of patients’ imaging investigations namely echocardiography, computed
tomography, MPS, cardiac MRI and coronary angiography were obtained from hospital database.
Age, sex, reason for each study, and clinical benefits gained were also recorded.
Results: There were 9569 patients registered at the Ischemic Heart Clinic with CAD. 97% underwent
echocardiography at least once during risk stratification process. Coronary angiography was
performed in 44% and some also underwent interventional procedure such as stenting. CT was done
in appoximately 20%, sometimes in private facilities. MRI was offered to patients who could afford
it (6%) as they were done in private hospitals. MPS is performed in one government hospital and in
one private hospital. Approximately 3.8% underwent MPS during the study period.
Conclusion: It is evident that the most commonly used modality was echocardiography as it is
the cheapest, most widely available modality. It is used for basic diagnosis and risk stratification.
Depending on the findings, coronary angiography was the following most used modality in patients
with high risk. Although it is invasive it was highly used because it is performed by cardiologists
themselves and some time is associated with therapeutic intervention. This modality was widely
available for free for patients in major government hospitals. Cardiac MRI is not widely performed
for evaluation of CAD or ischemic heart disease due to high cost and limited access. MPS is about
3 times more expensive compared to cardiac MRI limiting its use. Some cardiologists were not
fully convinced about usefulness and cost effectiveness of these two modalities.These are the major
challenges faced by country’s healthcare system. In developed countries MPS is widely utilized to
diagnose CAD and estimate the risk of adverse cardiovascular outcomes.Thereby it is possible to
reserve invasive modalities for patients with higher risk and optimize the risk-benefit ratio for the
patient. In developed world, the use of MPS to select patients needing CA is proven as a safe and
cost effective strategy. However our results show that this practice is quite different in Sri Lanka
and there is a significant underutilization of radionuclide cardiac imaging tests and MRI. This can
be mainly attributed to lack of financial resources and facilities.
Country/Organization invited to participate
Sri Lanka
Primary author(s) :
Presenter(s) :
Dr. PALLEWATTE, ARUNA (NATIONAL HOSPITAL OF SRI LANKA)
Dr. PALLEWATTE, ARUNA (NATIONAL HOSPITAL OF SRI LANKA)
Track Classification : Member States experience with other imaging modalities in cardiology (MRI,
CT, echocardiography)