Heart Disease Detection Goes High Tech
Experts review the latest techniques that reveal whether you have heart disease.
CT Scanning continued...
"The CT scan provides remarkably sharp images," Hazen says "The use of cardiac CT is going to explode. The images are spectacular."
Hazen isn't alone in his enthusiasm for this test. "The 64-slice CT scan is the most exciting new instrument we have," says Edward B. Diethrich, the founder and medical director of the Arizona Heart Institute in Phoenix. "The results we have seen in patient assessment and care are really fantastic."
Hazen does add that the 64-slice CT is not for everyone, "Data from the CT is acquired between beats so it doesn't provide as good of an image for people who are very large or who have an irregular heart rhythm or large calcifications in their arteries," he says.
Although there is no doubt that the images with the improved CT scanners are very sophisticated, there is still controversy about the significance of calcium measurements in predicting heart disease.
"The CT scan is good, but it is not as specific for heart disease because people sometimes have calcium in blood vessels and no heart disease or vice versa," says cardiologist Gerald Fletcher, MD, of the Mayo Clinic in Jacksonville, Fla. Fletcher is a spokesman for the American Heart Association.
Because of this controversy regarding calcification scores, most insurance companies do not cover the heart CT scan as a screening test. But Flectcher says "the horse is out of the barn and people are paying out of pocket for it, and it has value as a screening technique when taken with precautions."
Richard D. White, MD, the clinical director of the Center for Integrated Non-Invasive Cardiovascular Imaging at the Cleveland Clinic, also urges caution with the use of cardiac CT scans. Cholesterol screens, stress tests, and other traditional risk stratification methods "are still the backbone of understanding the propensity of a patient to develop coronary artery disease," White says. "It would be detrimental if we got so enamored with imaging that we put them completely on the back burner."
White says the CT scan is best used when doctors have a significant concern about a risk for coronary artery disease in patients who are clearly not in need of a catheterization. "A swing vote from cardiac CT would help to decide whether to commit a patient to more testing or therapy" he says.