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New CTA Heart Test Improves Risk Assessment
Clarence's 9th Visit to Cooper Clinic: Good News
I’ve just returned from having my ninth complete health and fitness exam at the Cooper Clinic in Dallas. I won’t have the report with complete results for several weeks, but one finding made possible by an exciting new technology is so satisfying that I can’t wait to tell you about it.
First, some background information for perspective. In 1998, electron-beam computed tomography (EBCT), ordered by my doctor and friend Arnie Jensen, at the Cooper Clinic showed calcification in my coronary arteries. Calcification is a marker of coronary artery disease. It often occurs early in the disease process before symptoms occur and can be an early warning sign. Discovery could save your life.
Calcification implies narrowing of the arteries, but does not prove it. A large amount of calcium can be present without significantly blocking blood flow--the calcium is often in the wall rather than the channel of the artery. Still, calcium is an important risk factor; it suggests the presence of soft plaque, which does not show up on EBCT scan. (Soft plaque hardens forming calcified plaque.) While calcified plaque is generally stable, soft plaque is more dangerous, more likely to rupture causing a coronary thrombosis or blood clot that blocks the artery.
Subsequent exams using thallium showed no indication of blockage in my coronary arteries. The thallium test is essentially an expanded treadmill stress test. The difference is that a small amount of thallium (a metallic element which shows up on X-ray) is injected into your arteries during the last minute of the test when your heart is under maximum stress. The test reveals if there are areas of the heart deprived of oxygen due to reduced blood flow. Dr. Jensen called my thallium test result "perfect."
(See article 105 in our Fitness and Health category for full details on my 1998 test results, and subsequent follow-up testing. GO SEE)
Things looked good at this point, but there were still some things we didn’t know. For example, is the calcium in the artery wall or the channel? Is there any narrowing of the coronary arteries? The gold standard for accurately assessing this is angiography or cardiac catheterization, where a thin plastic tube is threaded into the heart to clarify the extent of blockage.
Cardiac catheterization, however, is an invasive procedure with risks not warranted in cases like mine, where there is no chest pain, shortness of breath or other symptoms of heart disease.
Large Arteries—Little Blockage
Enter computed tomography angiography (CTA), a marvelous new technology installed at the Cooper Clinic since my last visit early in 2005. CTA is basically angiography—without the catheter. The Cooper Clinic acquired the equipment about 18 months ago and has done over 600 CTA evaluations.
CTA combines x-ray and computer analysis. X-rays are taken from several different angles to create cross-sectional images, which then are assembled by powerful computer software into three-dimensional pictures of the heart and its arteries. Compared to cardiac catheterization, which involves insertion of a sizable catheter and injecting contrast material through a large artery in the groin area, CTA is a much less invasive and more patient-friendly procedure: contrast material is injected into a vein in the arm using a small needle or IV. Again, no tube or catheter is required. CTA is also more cost-effective, usually not requiring hospital admission.
Nuclear cardiologist John S.Ho, MD, who conditioned his employment at the Cooper Clinic on purchase of the new CTA technology, spent about 15 minutes showing me computer images of my heart and coronary arteries from every imaginable angle. It was truly amazing.
Dr Ho showed me that my coronary arteries are “very large,” and that there is no significant blockage anywhere; the calcification is entirely in the lining of my coronary arteries. The obstruction present is “mild” at less than 20 percent. “Clinically severe lesions are generally 70-75% in severity,” Ho said. I’m not even close.
Dr Ho did caution me that CT angiography is a new technology and “not well validated.” It is possible that CTA has either under- or over-estimated the severity of disease in my case. As indicated, however, the Cooper Clinic has done over 600 CTA evaluations, and based on their experience with the technology my condition appears to be “mild and subclinical.” Dr Ho says, of course, that I should continue “aggressive risk factor control.”
No doctor can say with certainty, of course, but it sure looks like careful attention to fitness, body composition and healthy diet -- along with statin medication -- have paid off big time in my case.
Dr. McFarlin, who replaced Dr. Jensen as my doctor, is adamant that I must keep doing what I’ve been doing to insure that the disease does not progress. I absolutely intend to do that. I’m hopeful that my condition has stabilized, and might even reverse—testing in 2005 suggested that reversal may already be occurring. (See “Update” in article 105, Fitness & Health category. GO SEE)
That, of course, is the goal of preventive medicine. That’s why I go to the Cooper Clinic.
Ripped Enterprises, P.O. Box 51236, Albuquerque, New Mexico 87181-1236 or street address: 528 Chama, N.E., Albuquerque, New Mexico 87108, Phone (505) 266-5858, e-mail: cncbass@aol.com, FAX: (505) 266-9123. Office hours: Monday-Friday, 8-5, Mountain time. FAX for international orders: Please check with your local phone book and add the following: 505 266-9123
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