Cardiac Interventions TodayRural Structural Heart Care, Equity Gaps, and the Case for CT Fluency: Nidhi Madan, MD, MPH

🎓 Expert Commentary / Peer Perspective

Dr. Madan, a structural interventional cardiologist at Bassett Medical Center, describes the operational and clinical realities of growing a rural structural heart program, including TAVR, transcatheter mitral intervention, and left atrial appendage occlusion, while leading research at the intersection of advanced cardiac imaging and health equity.

What’s at Stake

• Patients in rural and underserved communities carry a disproportionate burden of structural heart disease yet frequently never reach a heart team conversation; Dr. Madan frames this as a central unresolved problem in the field, not an access abstraction
• CCT training remains deeply uneven across program types and geographies; published survey data show institutional culture, not individual effort, drives exposure, which is a gap Dr. Madan argues has direct patient outcome consequences as procedural applications expand
• The modern structural interventionalist functions simultaneously as advanced imager, heart team leader, patient advocate, and clinical scientist, a scope Dr. Madan argues demands training infrastructure that most programs have not yet built
• Patients with severe mitral annular calcification, complex degenerative anatomy, and advanced functional MR in low-EF settings represent the largest unmet needs in transcatheter mitral intervention, with current devices frequently inapplicable and no adequate alternative

What to Watch

• Follow SCCT Education Committee efforts to develop competency frameworks and curricula designed to reach physicians across all program sizes and geographies
• Track transcatheter mitral valve replacement platform maturation and CT-based anatomic phenotyping tools that may expand eligibility for currently excluded patient populations
• Dr. Madan identifies AI-assisted CCT analysis as a critical standard-setting moment for SCCT that is advancing faster than validation standards, regulatory frameworks, or medicolegal clarity
• Engage with SCAI, ACC, and SCCT early career and equity-focused programming as forums for advancing both training equity and structural heart access in underserved regions