The Enterprise: CTs Got the Beat

hiit040310.jpgA lot of excitement focuses on CT’s advancing domain into cardiology. Multidetector scanners, namely 40 and 64-slice, debuted over the last few years have made all the difference — finally giving CT the power to “stop a beating heart.”

Cardiac CT is especially useful in non-invasively evaluating the myocardium, coronary arteries, pulmonary veins, thoracic aorta, pericardium, and cardiac masses. It also is being used more often to identify both calcified and non-calcified plaque within the coronary artery walls or to exclude the possibility of significant stenosis brought on by atherosclerosis. Add some contrast and the third dimension and physicians can begin to see the early stages of atherosclerosis of the coronary arteries prior to the development of arterial narrowing. Wow. Cardiac CT allows for early detection of potentially unstable soft plaque as well as non-calcified plaque at a stage when they can potentially be reversed. And once seen, physicians can keep an eye on the regression on plaque with drug and other therapies.

But after years of rapid breakthroughs in cardiac drugs, and of course huge profits (about 17 percent of annual drug company revenues are derived from this class of drugs), pharmaceutical companies are now struggling to take heart medications to the next level — ironic at a time when we can visualize so much more. The good news is that a variety of heart regiments, namely statins, ACE-inhibitors, beta-blockers and aspirin, are working quite well. Cholesterol in the overall population is down while hospital admissions due to heart attacks are leveling off and, in some cases, declining.

Cardiac CT now is helping physicians to take a closer look and having great success. To bring that point home, check out “Cardiac CT is Making a Real Difference.” One leader in cardiac care, Washington Hospital Center in Washington, D.C., is reporting accuracy rates of 90 percent in establishing, with cardiac CT, a first time diagnosis or exclusion of coronary artery disease in patients with chest pain who have or have not had another type of antecedent non-invasive imaging stress test. The only concern? With a diagnosis that accurate and quick, will newly diagnosed cardiac patients take their disease seriously? I hope so.