Coronary Artery
Scanning (CAS) uses CT Scan which permits imaging of the coronary vessels
without any injections, needles or removal of clothing. You lie down, pictures
are taken over 30 seconds, and you’re done. The calcium in the atherosclerosis
is visualized and measured by a board-certified cardiologist at CT Scanner.
Studies have shown that this coronary calcium equates to coronary
atherosclerosis, which is the leading cause of myocardial infarction (heart
attack). It is, thus, well recognized that the early detection of coronary
atherosclerosis is of prime importance, and that the calcium detected on the
Heart Scan correlates with this atherosclerosis.
The Ultra fast
Heart Scan is an appropriate tool for otherwise healthy individuals who may be
at risk for heart disease: men over 35 or women over 45 who have risk factors
such as:
We recommend that
this test should be ordered in conjunction with your physician. We rely on your
physician to follow-up on this test, and treat you accordingly.
Coronary Artery
Scanning has the unique ability to detect and quantify minute amounts of
calcified plaque in the major coronary arteries. The traditional method to
detect these blockages is by an exercise treadmill test. Like most of tests in
cardiology, including the stress electrocardiogram (also known as treadmill
tests) or thallium stress tests or echocardiograms, are looking for advanced
blockages, and therefore can only reliably detect disease when the disease
process is far advanced. These tests can only detect blockages of 50% or more.
Any obstruction less than 50% will not cause enough limit of the blood flow to
produce a positive test. Even more expensive tests such as thallium tests cannot
detect obstructions less than 50%.
Unfortunately, most attacks occur from lesions that are only minor blockages.
These `minor' blockages suddenly rupture, causing a complete blockage. Since the
blockage wasn't causing a disruption of blood flow, the treadmill or thallium
would have been normal (negative) just prior to the heart attack. Thus, the
treadmill or thallium test, cannot detect these minor blockages, and yet the
person can have a heart attack.
The Coronary scan, on the other hand, is looking at coronary anatomy and not
function. This provides an opportunity to detect and measure plaque accumulation
from the point at which the very first speck of calcium is deposited in your
arteries. Typically, this is many, many years before high grade blockages can
occur.
What is
the significance of coronary artery calcium?
Calcification is
caused from the buildup of fatty streaks in the inner lining of an artery and
forms plaque. As the plaque builds and hardens it can reduce and block the flow
of blood through the artery. The plaque can rupture, become dislodged, or form a
blood clot leading to a heart attack.
Research study findings show that coronary artery calcium is a significant
marker of this atherosclerosis. More importantly, the early detection of
coronary calcium allows for the early detection of coronary artery disease, which enables patients to make changes in their
modifiable risk factors in order to stop, stabilize and perhaps even reverse the
atherosclerotic process.
Diabetes, tobacco use, high blood pressure, obesity, high cholesterol, sedentary
lifestyle and family history are important contributors to building
atherosclerosis, which can lead to a heart attack.
What is a
calcium score?
The calcium score
is a total of the amount of the calcified plaque in the coronary arteries. A
`normal' score is zero (no calcium in the coronaries). After a Coronary Artery
Scan, the Cardiologist measures the amount of calcification by using a highly
accurate computerized scoring technique. The total score is then compared
against research findings of 20,000 patients in many age groups. The physician
reviews and interprets all scores, images and test results to categorize the
person to low, intermediate or high risk of heart disease, and makes
recommendations on follow-up medical care to the patient’s physician.
A positive test means:
Coronary calcification indicates at least some coronary disease. The amount of
calcium is related to the amount of disease, and would guide your doctor in
recommending appropriate treatment, including diet, medication or further
testing.
A negative test means:
You probably don't have any coronary disease and
your risk of heart attack is very low. You may need to work on any modifiable
risk factors, and we may recommend another Coronary Artery Scan in 2 to 5 years,
but for now you can relax!
What does
the procedure involve?
The procedure is
simple, safe and painless and takes only a few minutes. Patients will complete a
risk factor questionnaire upon arrival. Our CT technologist will apply a few EKG
leads to your ankle and wrists, and will ask you to lie on a table and hold your
breath a couple times. The radiation exposure is minimal and no intravenous
injections or needles are required. In most cases (unless there are certain
types of buttons or bra metal involved), patients will be able to keep their
shirt or blouse on while the 30 or so pictures are taken.
Is
atherosclerosis treatable?
Yes, the
atherosclerotic process can be slowed, stabilized and actually reversed to some
degree through aggressive lifestyle modifications and/or through medication
therapies under the guidance of your physician. Our aim is to identify those
individuals with coronary atherosclerosis early,
before a heart attack, so that they may become active participants in halting the progression of this
disease process. By identifying atherosclerosis early, we hope to prevent the
onset of symptoms and/or a sudden coronary event.
How accurate is the coronary artery
scan?
The sensitivity
of this test is at least 95%, depending upon the research study. In other
words, if you have a blockage in your arteries, this test has at least a 95%
chance of being positive. Exercise treadmill testing, as a comparison, is about
70% sensitive. Also, if there is no calcium in your study (zero score) then
there is a >95% chance there is no significant blockage.
Is the
coronary artery Scan an adequate substitute for an angiogram?
A coronary artery
scan is not a substitute for an angiogram. A coronary artery scan is used for
the early detection of coronary artery disease while an angiogram is used to
measure the amount of narrowing in the coronary arteries. Due to the
invasiveness, the angiogram is not used as a screening test for atherosclerosis.
Do I need
a physician referral?
If
physician-referrals are not necessary, we accept self-referred men between the
ages of 35-70 and women between the ages of 45-75 years of age, who have one
additional risk factor for heart disease such as family history of heart
disease, high cholesterol, high blood pressure, diabetes, obesity, smoking, high
stress and physical
inactivity.
Depending on your insurance, physician referrals may or may not be necessary for
reimbursement. However, we encourage all of our patients to work with their
personal physicians. Please call for more details.
I have
had bypass surgery. Is the test useful to me?
The coronary
artery heart is not an indicator of luminal narrowing, but rather an indicator
of the atherosclerotic process itself. For those patients with established
disease, more advanced tests are necessary to accurately assess the extent of
the blockage. The Coronary Artery Scan would only confirm the presence of
atherosclerosis. However, there are non-invasive tests using the CT Scan to
assess if the bypass blockages are still open, and how tight (if any) the
blockages are. Talk to your physician about this non-invasive measurement of
your bypass grafts.
I have
chest pain. Is the test useful for me?
The Heart Scan is
recommended for patients with risk factors for coronary artery disease. Risk
factors include family history of heart disease, high cholesterol, high blood
pressure, diabetes, obesity, smoking, high stress and physical inactivity.
Patients with symptoms like chest pain should consult with their personal
physicians immediately. Symptoms for coronary artery disease are serious and
should not be treated lightly.
Is the
test/equipment approved by the FDA?
Yes,
the scanner has been cleared by the FDA and Coronary Artery Scanning is one of
the scanner's intended uses.
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