HEART CAT SCANS

Fast heart CAT scans have been a screening test in limbo. The exact role and place for this exam, which is becoming more widely available, hasn’t been well defined, until now.

The heart CAT scan has kind of been a pariah among major prevention groups. Fast CAT scans of the heart can show the amount of calcium in the coronary arteries, which can only be caused by heart blockages.

But does finding calcium help in preventing major events like a heart attack? The latest research shows, in the right patients, it can. It says that one in three Americans between the ages of 40 to 70 should be getting this test, a fast CAT scan of the heart to detect calcium in the coronary arteries.

Dr. Nathaniel Reicheck of St. Francis Hospital says while looking at one scan, “All of this bright stuff is calcium in this patient’s right coronary artery. People with advanced coronary disease often get this kind of heavy calcification.”

The new study in next week’s Journal of the American College of Cardiology shows heart CAT scans can be a highly useful predictor of a heart attack.

The researchers studied nearly 5000 seemingly healthy patients for more than 4 years and used a fast heart CAT scan like this one to measure the amount of calcium in the coronary arteries. They found that it is a better predictor of heart attack risk then conventional risk factors like high blood pressure high cholesterol and a history of smoking.

Dr. Alan Guerci, chief executive officer of St. Francis Hospital and the study’s author, says the heart CAT scan is ready for prime time for many patients. “It’s been understood for more than five years that this test predicts who is going to have a heart attack and who isn’t, who is going to need bypass and who isn’t. The study looks at whether the fast heart CAT scan predicts events like heart attacks, independently of standard risk factors, and it answers that question unequivocally.”

Guerci’s research shows calcium scoring using the heart CAT scan is appropriate for those considered at intermediate risk for coronary artery disease. That’s about a third of all Americans ages 40 through 70!
Intermediate risk means between a 10 and 20 percent risk of heart attack over ten years. It’s based on something called the Framingham Risk Index, which calculates a patient’s risk for a heart attack or stroke in the next 10 years based on factors such as age, cholesterol, hypertension, smoking and diabetes.

Detecting early that these patients are at risk can identify those in need of treatment methods, such as aggressive cholesterol lowering. “On the other hand in this intermediate risk group we were able to identify many who were at very low risk and wouldn’t need a cholesterol lowering medicine,” says Dr. Guerci.

“This is a good example of the most constructive role that the heart CAT scan plays, that is actually identifying people who may turn out to have normal coronary arteries, and keeping them out of the cardiac catheterization laboratory,” adds Dr. Reichek.

It appears that there’s a clear role for heart CAT scans, and they are being recognized as a major advancement in cardiac imaging that has a place in the lives of millions of Americans.

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64 SLICE CT SCANNER

62-year old Howard Fuhr was taken by surprise when he went to see his heart specialist. “I had an abnormal -um””stress test and um the next thing that my cardiologist suggested was having an angiogram and I wasn’t sure if I was ready to go that step,” says Howard.
So, he looked for the most cutting-edge technology he could find…what’s known as the “64-slice CT scanner. “I sought it out and I consulted with my cardiologist and we both agreed that this would be the way to go at this time,” states Howard.

The 64-slice CT scanner is the next-generation CT scanner. The number refers to its speed, almost like the shutter speed of a camera. It can grab pictures of the cardiovascular system in motion, and in approximately 10-seconds can give a technician a birds-eye view of what’s happening inside.

62-year old Howard Fuhr was taken by surprise when he went to see his heart specialist. “I had an abnormal stress test and the next thing my cardiologist suggested was that I have an angiogram, but I wasn’t sure if I was ready to take that step,” says Howard.
So, he looked for the most cutting-edge technology he could find – the “64-slice CT scanner. “I sought it out and I consulted with my cardiologist and we both agreed that this would be the way to go at this time,” he adds.

Dr. Jill Jacobs, a radiologist at New York University Medical Center says, “It’s very, very fast. So, because of its speed and it’s better resolution, it allows us to see such small structures like the coronary arteries.” With older CT scans, doctors could see only part of the coronary artery. Now they can see the entire thing. “We can see soft plaque, which in the past was difficult to see by any other test that was non-invasive,” adds Dr. Jacobs.

Typically doctors perform a cardiac catheterization – or the threading of a catheter through the groin and into the vessels – to see exactly how much narrowing or blockage there is. It is a common procedure, but not without risk. “There was a chance there could be damage to the blood vessels and the other possible complications such as bleeding or stroke,” states Dr. Jacobs.

This CT scan is non-invasive, and can double as a screening tool. Dr. Jacobs says, “It’s a very good test for excluding cardiac disease. That’s why it’s so good for people that have high cholesterol or family histories. People who are very nervous that they may have cardiac disease.”

The results can be pretty definitive. “If the study is absolutely normal, we can say with a certainty of about 97-98% that there is no coronary artery disease,” says Dr. Jacobs.
If the reverse is true and the test shows a blockage – doctors may then send the patient for a catheterization to see it first-hand.

It’s important to note that the 64-slice CT scanner is not likely to replace the gold standard, cardiac catherization. It is simply another tool doctors can use to diagnose disease. And it’s less-invasive, which is attractive to most patients.

Howard’s scan showed calcification””but was inconclusive. He may seek a catheterization anyway.