"As we enter a deceleration or indolent phase of [COVID-19] and a return to a 'new normal' for the foreseeable future, cardiovascular imaging laboratories will adjust to a different workflow and safety precautions for patients and staff alike," write William A. Zoghbi, MD, MACC, et al., in a new paper published in JACC: Cardiovascular Imaging offering recommendations for "ramping up safely."

The document, a collaboration between the journal editors and ACC's Cardiovascular Imaging Council, offers a general framework for multimodality cardiovascular imaging laboratories to use in balancing clinician and patient safety with necessary care during both the continued COVID-19 pandemic and the subsequent reopening/recovery phase. "Once the pandemic abates and the disease is controlled, the utilization and prioritization of various modalities would revert to usual and customary practice," Zoghbi and colleagues write.

The paper covers overarching topics from choosing the right test to scheduling considerations, while also offering up considerations by modality, including echocardiography, nuclear cardiology, stress testing (SPECT/PET/ECHO/CMR), cardiac computed tomography and CMR imaging. For example, the authors note that for transthoracic echocardiography (TTE), "good imaging practices can make the procedure safe and efficient in the peri-pandemic milieu." Among the TTE guidance:

• In COVID-19 (+) or suspected patients, the clinical relevance of the indication for TTE is paramount.
• POCUS or limited TTE can help assist bedside evaluation of cardiac structure and function and is particularly helpful in COVID-19 (+) to help expedite care and further triage patients who need a comprehensive TTE.
• The use of ultrasound-enhancing agents is essential in technically difficult studies to enhance assessment of regional and global function and attain a diagnostic study.
• As the pandemic is abating, comprehensive TTE should be aimed for with appropriate PPE and efficiency to address the myriad of clinical questions of cardiac and valvular function, pericardial diseases, and hemodynamics.

"Cardiovascular imaging is essential in the care of patients with heart disease," says Zoghbi. "In this document, we address the importance of both safety and imaging test choices, as we navigate difference phases of the COVID-19 pandemic." Both he and the authors note that moving forward "innovation, coordination and adaptation" will be necessary among patients, staff and patients in order to be successful.

Read the full document. A collaborative webinar between JACC: Cardiovascular Imaging and the ACC Imaging Section will address the recommendations on June 19 from 12 – 1 pm ET. Learn more and register.

Clinical Topics: COVID-19 Hub, Noninvasive Imaging, Echocardiography/Ultrasound

Keywords: COVID-19, Pandemics, Patient Safety, severe acute respiratory syndrome coronavirus 2, Echocardiography, Multimodal Imaging, Tomography, Hemodynamics

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