Testing for heart disease

Dr. Susan Locke discusses the pros and cons of some new tests for heart disease . . . . . .

Suan Locke, MD

Cardiovascular disease accounts for one in three deaths of American adults, according to the American Heart Association. Healthnetwork Foundation receives frequent requests for referrals to heart centers for diagnosis, treatment and second opinions.

One of the newer diagnostic tools for cardiovascular disease is cardiac calcium scoring, which is used to diagnose coronary artery disease, one of the most common forms of heart disease.

Cardiac calcium scoring (CCS), also known as coronary artery calcium scoring, is a new non-invasive test to detect and quantify calcium deposits in the coronary arteries.

The coronary arteries supply blood to the heart and normally don’t contain calcium. Calcium in the arteries is a sign of coronary heart disease.

The test is done by a special type of CT scan — electron beam computed tomography (EBCT) — which allows for more rapid scanning than traditional CT scans and allows for measurement of coronary calcium density and area. A cardiac calcium “score” is generated from the measurements.

A high calcium score suggests the presence of coronary heart disease. However, it is important to note that soft plaque cannot be found by CCS. Soft plaque is the earliest form of damage to coronary arteries. So if you have soft plaque, you may get a false-negative result. Test results may also be affected by a rapid heart rate, smoking and caffeine use.

The American Heart Association doesn’t recommend EBCT for general screening for heart disease. Richard Lang, MD, of the Cleveland Clinic Wellness Center says he doesn’t use CCS as a routine screening test during an executive physical. It may be a helpful tool when a patient has other cardiac risk factors like high LDL cholesterol, hypertension, diabetes, obesity, smoking history and strong family history of cardiovascular disease.

Richard Lang, MD

Lang also says CCS can be helpful in making decisions about how aggressively to approach risk factor management. Lang emphasizes that CCS is best used in conjunction with a “functional” study of the heart.

A stress echocardiogram or a myocardial perfusion imaging study is an example of functional studies that can provide your physician with valuable information about your heart. In the future, serial cardiac calcium scoring may become a tool for monitoring coronary artery lesions after lifestyle modifications or pharmacologic interventions.

An open dialogue with your personal physician is the best way to decide what testing is appropriate for you. Contact Healthnetwork for an appointment with a heart specialist or to schedule an executive health exam at one of our medical centers of excellence.

Susan Locke, MD, is Healthnetwork’s medical director.

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