Managing Patients and Resources in Nuclear RadiologyEduardo Pérez*Healthcare costs in the U.S. have increased rapidly in recent years and now exceed those in other nations that provide equivalent or better care. Increased demand for specialized services has been identified as one of the causes of this trend in U.S. healthcare costs. Machine time, direct labor time, and radiopharmaceuticals contribute the most to the total cost of each procedure in nuclear radiology. The way these resources are managed has a direct impact in the overall cost and the quality of service to the patient. Increased demand for nuclear radiology procedures coupled with the complexity of the procedures, make managing patient service and resources very challenging.
Functional mitral regurgitation in patients with coronary artery disease: Ischemic or Necrotic?
Jesus Peteiro, MD, PhD*
Functional (also called ischemic) mitral regurgitation (MR) in patients with coronary artery disease (CAD) is a disease of the cardiac muscle instead of a disease of the valve. This MR is produced by left ventricular (LV) global remodeling (dilation and sphericity) or regional remodeling in either case leading to tethering of the valvular apparatus towards a dyssinergic wall. This tethering may lead to restriction of the leaflets and incomplete closure of the valves in systole (Figure 1). Both valve closing force decrease due to LV systolic dysfunction and dyssynchrony may also have a role. This entity has been comprehensively studied in recent years with both resting and exercise echocardiography studies.