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Cardiac CT can detect heart disease sooner

Cardiovascular specialists use various tools to evaluate patients suspected of having coronary artery disease (CAD). No tool is 100 percent accurate, but when used in the appropriate patient population, some modalities can more accurately diagnose coronary heart disease in its early stages – before patients experience symptoms or doctors see the disease on EKGs or stress tests. 

One of the most accurate and widely used tests is Cardiac Computed Tomography, better known as Cardiac CT. This is a relatively new imaging method in which the patient is given contrast (dye) through a vein in the arm and images of the coronary arteries are obtained. These images differ from other modalities used in the diagnosis of CAD by providing a non-invasive angiogram, or road map, of the blood vessels of the heart. Stenosis, or plaque buildup, can be identified far in advance, before clinical symptoms are seen. Conventional methods of diagnosing CAD will not show any abnormalities until the disease has advanced to a point where plaque buildup is beyond 70 percent.

The importance of Cardiac CT is that its negative predictive value is 99 percent. In other words, if the Cardiac CT is negative for CAD, you can be virtually certain there is no CAD. A negative stress test, however, leaves some uncertainty. For example, if a patient has a moderate obstruction of 40 to 50 percent in one of the blood vessels to the heart, his/her stress test could still be negative -- which means the blockage could be missed. That same blockage would be very evident in the images acquired with Cardiac CT. When non-critical or non-obstructive coronary heart disease is found, aggressive risk-factor modification will follow, likely including cholesterol/lipid management, exercise and control of hypertension and diabetes.

You may be shocked to know that in autopsy studies of sudden cardiac death patients, the average blockage found is in the range of 50 percent. Furthermore, a myocardial infarction (heart attack) does not require an obstruction that is 80 or 90 percent. Coronary artery disease consists of a plaque cholesterol buildup in which an inflammatory reaction occurs. When the plaque ruptures, the person is exposed to plaque elements such as cholesterol and inflammatory cells that will initiate the formation of a clot. This is the onset of acute coronary syndrome, which can range from unstable angina to acute myocardial infarction, depending on the extent of the clot that is forming and how much that clot is obstructing the blood vessel. Identifying the disease at an early stage is an important part of primary prevention. Once the disease manifests itself as chest pain, unstable angina or acute myocardial infarction, all the tools that we have been using for the past 25 years will be available to treat the disease. 

The increased use of Cardiac CT will lower the cost of evaluating and treating patients with cardiovascular diseases in the following ways:

1. The number of heart catheterizations should decrease. Catheterizations are often done to clarify results of other non-invasive studies that are inconclusive.
2. Hospital admissions for chest pain should decrease because life-threatening diagnoses such as pulmonary embolism, aortic dissection and CAD can be excluded with Cardiac CT.
3. Most important, by earlier detection of CAD, aggressive therapy can be initiated as part of primary prevention.

Carlos Grullon, MD, is a Lake Mary resident practicing at The Cardiovascular Center, P.A., with offices in Lake Mary and Deltona.  He is board certified in the fields of internal medicine, cardiovascular disease, nuclear cardiology, interventional cardiology and cardiac CT angiography.