{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:08:19Z","timestamp":1790604499375,"version":"4.1.0"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Cardiac diagnostic testing continues to evolve, and controversies remain regarding the optimal utilization of different procedures. We sought to evaluate changes in long-term utilization trends for a wide range of cardiac diagnostic tests in the context of advancing technologies and updated guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Annual cardiac testing volumes from 2010 to 2022 in the Medicare Part B population were compared across tests and by provider specialty and analyzed using Joinpoint regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>The most-utilized test in the Medicare population remained transthoracic echocardiography, accounting for 61.5% of cardiac testing use in 2011 and 67.7% in 2022, followed by single-photon emission computed tomography (CT) myocardial perfusion imaging, which decreased from 20.8% to 12.9%. Single-photon emission CT myocardial perfusion imaging use decreased relative to positron emission tomography myocardial perfusion imaging (ratio of 39:1 in 2011 to 7:1 in 2022), stress cardiac magnetic resonance (1179:1 in 2011, 268:1 in 2022), and coronary CT angiography (61:1 in 2011, 10:1 in 2022). Decreased use was also observed for exercise treadmill testing (2.3% to 1.7%), stress echocardiography (3.6% to 2.6%), multigated acquisition (0.4% to 0.1%), and invasive coronary angiography (8.0% to 7.0%). The use of fractional flow reserve by CT per 100\u2005000 Medicare enrollees increased by &gt;16-fold from 2018 (the first year covered) to 2022, and cardiac amyloidosis pyrophosphate scintigraphy studies increased 4-fold from 2011 to 2022 (0.17% to 0.68%). Positron emission tomography myocardial perfusion imaging volumes have surpassed exercise treadmill test volumes and, assuming the current rate of change continues, are projected to surpass stress echocardiography volumes in 2024. Coronary CT angiography is projected to overtake exercise treadmill testing in 2024 and stress echocardiography in 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Between 2010 and 2022, cardiac diagnostic testing in the US Medicare population shifted from invasive angiography and traditional stress testing toward an increase in cardiac CT, cardiac magnetic resonance, and positron emission tomography. Pyrophosphate scintigraphy studies also increased, as did fractional flow reserve by CT since its introduction. Changes in preferred diagnostic modalities suggest a need to reevaluate current recommendations for training in cardiovascular medicine.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.124.017567","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T05:01:15Z","timestamp":1741842075000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Temporal Trends in Noninvasive and Invasive Cardiac Testing From 2010 to 2022 in the US Medicare Population"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4354-7244","authenticated-orcid":true,"given":"Yosef A.","family":"Cohen","sequence":"first","affiliation":[{"name":"Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital (Y.A.C., M.S., M.C., L.L.J., A.J.E.)."},{"name":"Department of Epidemiology, Columbia-Mailman School of Public Health, New York, NY (Y.A.C.)."},{"name":"Children\u2019s Hospital at Montefiore, Department of Pediatrics, New York, NY (Y.A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4950-6793","authenticated-orcid":true,"given":"Luca","family":"Bremner","sequence":"additional","affiliation":[{"name":"Vagelos College of Physicians and Surgeons, Columbia University, New York, NY (L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3263-5134","authenticated-orcid":true,"given":"Mrinali","family":"Shetty","sequence":"additional","affiliation":[{"name":"Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital (Y.A.C., M.S., M.C., L.L.J., A.J.E.)."},{"name":"Division of Cardiovascular Medicine, University of Louisville, KY (M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3576-1630","authenticated-orcid":true,"given":"Michelle","family":"Castillo","sequence":"additional","affiliation":[{"name":"Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital (Y.A.C., M.S., M.C., L.L.J., A.J.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia Susan","family":"Cappell","sequence":"additional","affiliation":[{"name":"Columbia College, Columbia University, New York, NY (J.S.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9940-2610","authenticated-orcid":true,"given":"Jay S.","family":"Leb","sequence":"additional","affiliation":[{"name":"Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital (J.S.L., A.J.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5356-3905","authenticated-orcid":true,"given":"Lynne L.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital (Y.A.C., M.S., M.C., L.L.J., A.J.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2583-9278","authenticated-orcid":true,"given":"Andrew J.","family":"Einstein","sequence":"additional","affiliation":[{"name":"Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital (Y.A.C., M.S., M.C., L.L.J., A.J.E.)."},{"name":"Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital (J.S.L., A.J.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.11.007"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1415516"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.12.040"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001030"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv444"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.10.054"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S105613"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1148\/ryct.2021210156"},{"key":"e_1_3_3_10_2","unstructured":"Medicare Monthly Enrollment. 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