Frequently Asked Questions
My doctor has never told me about this
procedure...why?
Electron Beam (Ultrafast) CT
is a relatively new, highly specialized and sophisticated imaging
tool mostly located at major university hospital centers around the
world (Mayo Clinic, Baylor, UCLA, etc.) Its arrival in Denver in
1998 at Colorado Heart and Body Imaging, represented the very first
center in our Rocky Mountain region. Front Range Preventive Imaging
now brings this remarkable technology to the areas north of Denver.
There are now hundreds of published papers and numerous textbook
chapters concerning coronary artery calcification and its importance
as it relates to electron beam CT. Your physician may not be
familiar with the latest studies proving the value of this
technology.
If it is new to this region, then how can the
results be understood?
Fortunately, there is a great worldwide experience
with this scanner, and its accuracy and predictive ability have been
proven in numerous scientific papers. We, at Front Range Preventive
Imaging have access to the results from thousands of patients
studied throughout the world so we can best match your score with
others by age and sex. It has become clear that most patients
develop some degree of atherosclerosis as they get older, and this
instrument is the only way to determine if an apparently healthy
person has begun the process at above or below the expected rate.
What is the
significance of calcification and the Coronary Artery Calcium (CAC)
score?
Coronary calcification is a marker for coronary
plaque and typically appears years before the development of
symptoms of heart problems. This is truly "hardening of the
arteries". The
score that you receive represents the total amount (based on
size and density) of the calcium deposits found in all of your
coronary arteries. For all age groups, the higher the score, the
more coronary disease is present and the greater the likelihood that
it may result in a heart attack or chest pain in the future, if left
untreated. Most men of over the age of 40 and women over 50 will
have some degree of calcification, so do not be alarmed if your
score is not zero.
My doctor told me that worrisome plaque is often
non-calcified...but aren't you only measuring the calcified plaque?
That is correct. There are no current noninvasive
methods that will identify all plaque. However, the calcified
portion (measured by
ultrafast CT) is a useful marker for total plaque. There are
numerous studies in the medical literature that have shown the
relationships between calcified plaque and total plaque. Calcium is
important because it signifies the "tip of the atherosclerotic
iceberg". The
calcification score, correlates remarkably well with one's
individual risk for a heart attack. Several studies show that
the calcification score is a better predictor of a heart attack than
a coronary angiogram.
I have no major risk factors for heart disease, I
exercise regularly and I am very careful about my diet. Does the test
have the same value for me?
In the absence of other risk factors, an elevated
coronary artery calcium score is still very predictive for risk of a
future myocardial infarction. For some individuals, a coronary
calcification score is the only indication that they may be at
higher than expected risk for a heart attack.
Why would I (or my doctor) want to know this
information? What can be done?
We currently have powerful tools for preventing the
progression of coronary artery disease in individuals with early
disease. We at Front Range Preventive Imaging want to help your
physicians take advantage of the results from thousands of patients
who have benefited by these management strategies...but first we
need to know exactly who is at risk.
I recently had a stress test that was perfectly
normal but I have some coronary calcium on the ultrafast "CardioScan"
test. Does that mean that this test or the stress test was wrong?
No. Although both tests were looking for heart
disease, they are doing it in different ways. Your normal stress
test indicates that the plaque buildup which was seen on the heart
scan has not yet reached the point where it is interfering with the
blood supply to your heart. Your heart scan tells us that the
process has indeed begun, and there is an opportunity to modify all
controllable risk factors to minimize the chance that you'll ever
have a heart problem.
Can you tell me how much blockage there is in my
coronary arteries?
Although it is possible for us to make some
generalizations about the degree of coronary narrowing that likely
exists, it is not a primary purpose of this test. The primary
purpose of the test is to detect disease before there is much
narrowing. Doctors now know that more than half of all heart attacks
occur at sites of less than 50% narrowing. No other noninvasive test
in cardiology can detect this type of early disease.
What kind of report will be created based upon my
score?
A board certified cardiologist or internist
and a technologist will examine the series of pictures obtained by
the scanner and calculate the total amount of calcification (the "
calcium score") present. From the information available, we will
report the location and degree of anatomy may be recorded. A further
cardiology panel report will also be included revealing the overall
significance and general recommendations based upon your score. The
report will be useful to you and your doctors to review
recommendations for management. Ultimately, your personal physician
(not Front Range Preventive Imaging) will be the best individual to
determine the proper course of action for you. We are always
available to you and your doctor for consultation.
I have a normal cholesterol reading. Can I still
have coronary disease?
Having normal cholesterol puts you at a lower risk
than average for heart disease. However, over 50% people with
coronary artery disease have average cholesterol. It is now clear
that some people with average cholesterol need further lowering by
medications or diet.
Should I obtain a physician referral for this test
or should I make an appointment independently of my doctor?
This is largely a personal decision. We, at Front
Range Preventive Imaging believe that it is much more likely that
the information provided at our center will be best utilized if your
personal physician is aware of the test results. In general, a well
read physician is best able to understand the overall importance of
this test in the context of your medical history and physical exam.
Your doctor may also have access to other important medical records
that could help in the overall assessment of your situation. In
addition, it is more likely that insurance companies will
participate in the reimbursement of this procedure with an
appropriate physician referral. In the majority of circumstances,
the general recommendations on therapy or further testing will
necessitate physician involvement and review of our findings. Some
patients would rather keep the information confidential to all
entities (including their doctors) and we respect those wishes.
— Questions relating to body—
My body scan was entirely normal….does that mean I
am totally healthy?
A body scan is an anatomic (radiologic) survey of
the major structures in the chest and abdomen and should be regarded
as a possible opportunity to find early structural abnormalities,
masses and vascular plaque. Although a normal body scan should be
regarded as generally reassuring, it is certainly true that there
are many diseases that can only be detected by other methods, if at
all (blood testing, antigen testing). In addition, a body scan does
not involve intravenous contrast material. Therefore, it should be
considered a rather inexact science especially for detection of
certain abdominal conditions.
The radiology report mentioned a problem with my
lungs, chest or an organ in my abdomen. What do I do now?
Hopefully, our report offered general
recommendations for follow up with your doctor and sometimes
mentions further testing that could be useful. We are available to
you and your doctor to clarify our report. In some circumstances, we
will speak with your doctor directly and provide films for his/her
review.
Is the body scan ever covered by insurance?
Although a body scan may be provided as a special
"perk" by some employers, in general, it will not likely be covered
by insurance. In general, the total body scan is not considered
medically necessary. The heart scan component is often necessary to
help a doctor make lifelong decisions and will sometimes be covered
by your insurance company.
— Questions relating to Colon—
coming soon
— Questions and Concerns—
1. I received the
report and I still don't know what it all means for me.
Advice:
If you have a physician who knows your history and
who understands this test, bring the report to your
doctor to see if you should be on treatment to lower
your risks. If you do not have a doctor or would
like to visit with one of our experts, call our
center and ask for a physician consultation.
2. The
report says I have more plaque than 75% or 90% of people
my age and gender. What should I do now?
Advice:
People with scores in the top 25% (above 75%) are at
22 times the risk of those who have less plaque than
75% of peers. Remember, if you have any symptoms
(chest pain, etc.), see a physician immediately. If
you have risk factors for heart disease (e.g. high
cholesterol, hypertension, family history of early
heart problems, etc.) and your score is greater than
80, you should probably be treated according to
"secondary NCEP guidelines". In other words, your
LDL cholesterol (bad cholesterol) should be lowered
below 100 by medications. Visit a physician.
3. My coronary
calcium score is very high—your report says it is
severe. What do I do now?
Advice:
If you have symptoms like chest pain, see a doctor
immediately. If you do not have chest pain or other
symptoms, you will need to be on aggressive risk
reduction strategies under a physician's care to
stabilize plaque. Most people will be considered for
placement on a statin drug (cholesterol lowering
drug) regardless of the baseline cholesterol level.
We now know that patients on such medications will
have their risks lowered substantially. In addition,
future heartscans should show that the rate of
progression (worsening) has been decreased. Many
patients with severe scores (over 400) should also
be considered for ACE inhibitor drugs like Altace.
In addition, most people will need to get a stress
imaging test by a cardiologist to verify that there
is no significant blockage. About 20-35% of people
with scores over 400 will have such hidden
narrowing.
4.
I sometimes have shortness of breath, chest pain or
discomfort. However, my heartscan results did not show
much plaque. What should I do?
Advice:
Any recent onset of chest symptoms need to be taken
seriously regardless of a favorable calcium score.
You should visit a knowledgeable physician who will
try to determine whether your symptoms are indeed,
cardiac in origin. He/she may perform other tests
(stress) to look for hidden coronary blockage.
Patients with symptoms can indeed have blockage with
soft plaque, even with a zero or low calcium score.
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