Cardiac and radiology specialists at the University of Rochester Medical Center are using leading-edge technology to see the heart and its vessels more clearly than ever before, instead of performing more invasive tests some patients may not require.
Called CT angiography, or computed tomography angiography, the technology allows physicians such as cardiologist John P. Gassler, M.D., assistant professor of Medicine/Cardiology Unit, and radiologist David A. Dombroski, M.D., assistant professor of Imaging Sciences, to create detailed images of the heart arteries to ascertain if a patient requires traditional invasive diagnostic angiography.
This latest advance in noninvasive cardiac imaging allows for visualization of internal structures within the human body by creating a collection of 64 thin-slice images that, when combined, form a three-dimensional view of the patient’s anatomy.
This level of detail provides an opportunity when caring for patients considered low-risk who have atypical chest pain, or patients who have had a stress test with slightly abnormal results, for physicians to quickly and non-invasively eliminate coronary artery disease as the source of the symptoms.
Before the CT angiography technology was available, low-risk patients were automatically sent to the catheterization laboratory to undergo a diagnostic angiogram to get the best picture of their heart health. In about 20 percent of cases, the angiogram showed there was no coronary disease, and thus the need for the invasive study had been unwarranted, albeit unknowingly. This new technology provides an additional check early on for low-risk patients and can eliminate unnecessary trips to the catheterization laboratory to rule out coronary disease.
“For patients who are slightly symptomatic, or have a stress test or echocardiogram that might very well be a false-positive, this diagnostic test can serve as an interim step before heading into the catheterization lab,” Gassler said. “Catheterization itself is low-risk, but if we can help some patients avoid the need for an angiogram, we eliminate the risk, reduce the amount of time spent testing, and we reduce the health care cost.”
The cardiology and radiology experts at Strong Memorial have performed more than 130 CT angiography scans. Of those patients, 10 percent required a follow-up catheterization.
Patients who undergo the diagnostic test are injected with a safe dye, which allows physicians to see whether heart artery blockages exist. The diagnostic scan itself requires a breath hold of 10 seconds; total time in the hospital can be up to 1.5 hours.
Cardiologists or radiologists specifically trained in CTA interpretation then read the completed scans to determine whether there is coronary disease present and whether the patient should be brought into the catheterization lab for a traditional angiogram to further assess whether treatment is necessary.
“The 64-slice imagery allows us to see a detailed look at the heart, as well as the lungs and chest structure, sharing an unprecedented view that ultimately can save the patient from having to undergo a minimally invasive procedure unnecessarily,” Dombroski said. “It is an incredibly powerful tool to help us better diagnose and manage heart disease.”