Non-Invasive Coronary Angiography with Adventist Heart and Vascular Institute

 
 

The ability to perform a completely non-invasive coronary angiogram, the Holy Grail of cardiology for almost 30 years, has finally become reality. A recent advance in CT scan technology, specifically the development of 64-detector CT scanners, now allows cardiologists to visualize the blood vessels of the heart with a 5 second, non-invasive scan (Cardiac CTA).

Coronary angiography (also known as cardiac catheterization), has been the best and most important test for evaluating the blood vessels of the heart for almost 50 years. In this procedure, a patient typically enters the hospital in the morning and undergoes an invasive procedure where a small tube called a catheter is placed in an artery in the leg (or sometimes the wrist) and advanced under X-ray guidance to the heart, where contrast dye is injected to make a movie of the blood vessels on the surface of the heart. This angiogram shows which of the vessels are narrowed and how severely, and helps your cardiologist decide along with you the best treatment options. These options may include balloon angioplasty with stent placement, heart bypass surgery, or medical therapy.

Coronary angiography has a long history of guiding treatment decisions that help people live longer, healthier lives. It will continue to be an important tool in the fight against heart and vascular disease for the foreseeable future. However, about 1-in-4 people who undergo an angiogram do not have significantly blocked vessels, and we would like to avoid an invasive procedure in those people if possible. In addition, invasive coronary angiography has an associated risk of complications of about 1-2%. Although major complications such as heart attack or stroke are quite rare, vascular complications (abnormal bleeding or clotting of the blood vessel at the site of the angiogram) are more frequent, and can lead to pain, prolonged bed rest or hospital stay, and occasionally blood transfusion or even emergency surgery. Cardiac multi-detector CT angiography ( cardiac CTA ) is a new method of visualizing the blood vessels of the heart by injecting the contrast dye through a small IV in the vein of the arm, and rapidly acquiring images of the blood vessels of the heart when they are filled with dye. By injecting the contrast dye through an IV instead of through one of the major arteries, we are able to avoid the risks of vascular damage, heart attack or stroke. The actual scanning of the heart takes only about 5 seconds, during which time the patient is asked to hold their breath. The IV is then removed, a band aide placed and the patient may go home, to work, or to the golf course immediately! A report should be ready for your doctor the next day.

Cardiac CTA is not perfect, and many people with suspected heart disease will still require a standard invasive angiogram. People with severe angina or high-risk stress tests generally ought to have a coronary angiogram instead of cardiac CTA. In addition, people with irregular heart rhythms such as atrial fibrillation are currently very difficult to image with cardiac CTA. Invasive coronary angiography may actually be safer in some people with kidney failure, and is better in people who have severe calcification of the blood vessels of the heart or those whom we suspect will need open heart surgery.

Cardiac CTA will be excellent in those people who have an abnormal stress test but who we still believe are unlikely to have significant heart disease. Many of them will be able to avoid the need for an invasive coronary angiogram. It will also be excellent for people with non-diagnostic stress tests, or even with negative stress tests in whom we are still concerned there is a high risk of coronary artery disease. President Clinton had annual stress tests, all of which were negative, yet had severe coronary disease eventually required urgent heart surgery. Cardiac CTA will also be a good test for evaluation of some patients with heart failure of unknown cause, and for patients with suspected abnormalities of the course of the blood vessels of the heart (anomalous coronary arteries). CTA is also excellent for looking at the carotid arteries (blood vessels to the brain), the renal arteries (blood vessels to the kidneys) and the blood vessels of the abdomen and legs.

At Adventist Heart and Vascular Institute, we believe the advent of cardiac CTA is the most important advance in cardiology since coronary angioplasty was first performed in 1977. Its uses and usefulness will continue to improve, and some experts believe it will eventually completely replace invasive coronary angiography. We are proud to be one of the very first cardiology practices in the world to offer this to our patients, and we strive to provide our patients with the best, most advance heart and vascular care. The treatment of patients with heart and vascular disease is advancing by leaps and bounds, and the future is limitless. We will continue to practice at the forefront of cardiology.

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