In the United States, one in every four deaths is caused by heart disease, accounting for 600,000 deaths each year, according to the US Centers for Disease Control. For both men and women, heart disease is the leading cause of death, and every year around 720,000 Americans suffer heart attacks. More than 70% of the heart attacks that occur each year in the US are first heart attacks. When the cost of healthcare services, lost productivity, and medications are considered, coronary disease costs the US nearly $109 billion per year.
Heart disease can be diagnosed before it causes major problems, and in some cases it can be diagnosed before a person even experiences symptoms. A number of different radiology imaging techniques are used in the diagnosis of heart disease.
Coronary CT Angiography (CTA)
Coronary computed tomography angiography (CTA) is a noninvasive cardiac test that uses x-rays to create three-dimensional images of heart anatomy. In some cases, a dye is injected into the circulatory system to provide for greater image contrast. This technique has been shown to decrease the length of hospital stays and reduce hospital costs. CTA is especially useful in diagnosing abnormalities such as intra-cardiac tumors, blood clots, coronary artery anomalies, congenital heart disease, and pericardial disease. It is also less risky than traditional cardiac catheterization imaging.
Those who benefit most from CTA are people without symptoms but who have significant risk factors for coronary artery disease. This type of radiology imaging is also useful for patients who have had non-diagnostic nuclear stress tests, cardiac catheterizations, or echocardiograms.
Calcium Score Screening Heart Scan
A calcium score screening heart exam detects calcium deposits found in plaques in diseased coronary arteries. This type of scan also uses CT, and is the most effective way to detect early hardening of the arteries before symptoms develop. The amount of coronary calcium is a powerful predictor of future heart problems, and is helpful in guiding preventive care. If calcium is detected, a calcium “score” is calculated to estimate the extent of coronary artery disease. An absence of calcium doesn’t completely rule out heart disease however, since “soft plaque” atherosclerosis is not detected with this type of test. Calcium score screening is a type of radiology imaging that does not require injection of contrast dye, and only takes a few minutes.
Doctors can evaluate myocardial blood flow using positron emission tomography (PET), a radiology imaging technique that has been shown to detect multi-vessel coronary artery disease better than when other diagnostic techniques are used alone. In a study presented to a meeting of the American Society of Nuclear Cardiology in 2013, patients diagnosed with one-vessel coronary artery disease by traditional myocardial perfusion imaging were often discovered to have multi-vessel disease when myocardial blood flow was examined using PET. Additionally, many patients originally diagnosed with two-vessel coronary artery disease were discovered to have more extensive disease when they were evaluated further using PET.
Coronary Angiography Using X-Rays
Also known as coronary catheterization, coronary angiography is a technique that has been around for a long time. With this type of radiology imaging, x-ray motion pictures of blood inside the coronary arteries are recorded after a physician guides a catheter through the large arteries of the body until the tip of the catheter is just inside the opening of one of the coronary arteries. One of the main advantages of coronary angiography is that doctors can use a guiding catheter rather than a diagnostic catheter during the procedure to guide certain instruments (like guide wires and balloon dilation catheters) into a designated artery. With balloon catheters, the physician can inject a contrast agent into the balloon and expand it to open up narrowed blood vessels.
Magnetic resonance imaging (MRI) is another radiology imaging technique that can be used to evaluate cardiac anatomy and ventricle functioning. It has been shown to be an excellent diagnostic method for evaluation of myocardial ischemia and infarction. Though MRI doesn’t expose patients to radiation as CT and angiography techniques do, it is a technically demanding and expensive procedure because of the bodily motions of the heart pumping as well as the patient’s breathing. But it can be used to detect a phenomenon called coronary arterial remodeling, which refers to changes in blood vessel size or wall structure in patients with coronary disease who may have no symptoms. Additionally, cardiac MRI can detect whether a patient had an unrecognized or asymptomatic heart attack, and this knowledge can be very valuable because of increased mortality risk with asymptomatic heart attack.
Stress echocardiography is a type of radiology imaging that uses ultrasound rather than radiation or magnetic fields to create images of the heart. This type of imaging can be used to screen patients without symptoms who are nonetheless at high risk, and it is often used before major non-cardiac surgery. Diagnostic stress echocardiography can help doctors assess risk for future cardiac events by distinguishing between patients with high, median, and low risk. It can also be used in symptomatic patients with chest pain and without known coronary artery disease to help predict cardiac events better when used along with clinical data and electrocardiogram data. Echocardiography may also be used in the diagnosis of diseases of the heart valves or abnormal heart structures.
Advanced medical imaging techniques are essential in diagnosing coronary disease, which is the number one cause of death of both men and women in the US. When coronary disease is detected early, lifestyle changes and other interventions can greatly improve the patient’s prognosis. When a person experiences possible cardiac symptoms, radiology imaging helps physicians diagnose the problem with either noninvasive or minimally invasive procedures that are fast, safe, and accurate. Knowing which technique to use in a given situation requires the skill of radiology specialists with specific training and experience in cardiac radiology.
SteleRAD is a radiology practice owned and operated by board certified, fellowship-trained radiologists. Dr. Richard Spira, Dr. David Ring, Dr. Charles C. Cole, and Dr. Carl Raboi are trained and experienced in the sub-specialty of cardiac radiology, including cardiac CTA, which is considered the “gold standard” in cardiac diagnostic imaging. For over 40 years, the radiology professionals of SteleRAD have worked hard to improve patient experience and patient outcomes in South Florida using the latest in radiology imaging. If you would like to know more, contact SteleRAD online, or call 954-358-5250.