Current status of nuclear cardiology practice in Latin America and the Caribbean, in the era of multimodality cardiac imaging approach: 2022 update

Abstract

Cardiovascular diseases (CVDs) are the leading cause of mortality in Latin America and the Caribbean (LAC), with the risk in men being slightly higher than in women. The coronavirus disease 2019 (COVID-19) pandemic caused a significant reduction in the number of cardiac diagnostic procedures globally and in particular in LAC. Nuclear cardiology is available in the region, but there is variability in terms of existing technology, radiopharmaceuticals, and human resources. In the region, there are 2385 single photon emission computed tomography (SPECT) and 315 PET scanners, Argentina and Brazil have the largest number. There is an increasing number of new technologies such as cadmium-zinc-telluride (CZT) cardiac-dedicated gamma cameras, SPECT/computed tomography (CT), and PET/CT. All countries performed myocardial perfusion imaging studies, mainly gated-SPECT; the rest are multi-gated acquisition, mainly for cardiac toxicity; detection of viability; rest gated SPECT in patients with dilated cardiomyopathy, and bone-avid tracer cardiac scintigraphy for transthyretin cardiac amyloidosis diagnosis. Regarding other non-nuclear cardiac imaging modalities, Argentina, Colombia, and Chile have the highest ratio of CT scanners, while Brazil, Argentina, and Chile show the highest ratio of MRI scanners. The development of nuclear cardiology and other advanced imaging modalities is challenged by the high cost of equipment, lack of equipment maintenance and service, insufficient-specific training both for imaging specialists and referring clinicians, and lack of awareness of cardiologists or other referring physicians on the clinical applications of nuclear cardiology. Another important aspect to consider is the necessity of implementing cardiac imaging multimodality training. A joint work of nuclear medicine specialists, radiologists, cardiologists, and clinicians, in general, is mandatory to achieve this goal.

Cardiovascular testing recovery in Latin America one year into the COVID-19 pandemic: An analysis of data from an international longitudinal survey

“…For example, only 5 surveys were collected from the Caribbean, potentially reflecting scarcity of cardiovascular imaging centers in the region, which could impact the generalizability of our findings. Indeed, a recent survey found that Cuba, the only Caribbean country included in the study, had fewer than five CT scanners per million inhabitants in 2022, and less than one MRI scanner, PET scanner, and cyclotron per million, [43] and as of 2020, Haiti, the most populous country in the region, had only four CT scanners serving over 11 million people, according to IAEA/Pan American Health Organization estimates, [44] and to the best of our knowledge none of these are used to perform coronary CTA. These statistics highlight the urgent need for international initiatives aimed at improving access to medical imaging in the Caribbean, such as those headed by the American College of Radiology Foundation and RAD-AID in Haiti [45] , [46] .…”

How international organizations can support the development of cardio-oncology in the Latin American and the Caribbean region

“…Countries with the highest number of scanners (CT, MRI, SPECT, and PET-CT) per million inhabitants are Argentina, Brazil, Chile, and Colombia, showing a substantial difference from the rest of the countries. 7 As a result, all of these factors contribute to disparities in patient care.…”