My doctor has never told me about this procedure…why?
Electron Beam (Ultrafast CT), or EBT Heart Scan, is a relatively new, highly specialized and sophisticated imaging tool mostly located at major university hospitals and medical centers (Mayo Clinic, Baylor, UCLA, etc.). Front Range Preventive Imaging is the only facility in Colorado that offers this remarkable technology. There are hundreds of published papers and numerous textbook chapters discussing coronary artery calcification and its importance as it relates to electron beam CT, or EBT heart scans. 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 the EBT scanner. Its accuracy and predictive ability for heart disease have been proven in numerous scientific papers and clinical settings . You receive a clear and easy to understand detailed report of your heart scan results. We also provide you with an age and gender matched comparison from a data bank of thousands of patients studied throughout the world so we can best match your score with others by age and gender. This way you can easily get a sense of where you are “heart-wise” compared to others your age. The data shows that most people develop some degree of atherosclerosis (plaque) as they get older, and the EBT heart scan is the best instrument that exists to date 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. Calcium is a component of arterial plaque and due to its density, it is easily and accurately picked up by the EBT scanner. The score that you receive, called your Calcium Score or “CAC Score”, represents the total amount (based on size and density) of the calcium deposits found in all of your coronary arteries. You will also receive a score for each of the 4 major coronary arteries individually. Scores range from 0 to the highest one we have ever found which was 9,000. 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. Roughly 33% of men 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 EBT) is a useful marker for total plaque and to establish a baseline calcium score. There are numerous studies in the medical literature that show 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.
Your first heart scan will show if you have heart disease or not. Your second heart scan will show if the plaque you have is calcified (stable) or non-calcified, i.e. soft plaque. If a positive calcium score does not increase by more than 15% in a 12 month period, this indicates that the existing plaque is stable and is very unlikely to rupture to cause a coronary event. Only an EBT heart scan is accurate enough to compare scans on a yearly basis.
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?
Yes, it is probably the most valuable test anyone can have. Common risk factors, regular exercise, and careful diets are very weak indicators of heart disease. Now that we have the technology, it is far safer to assume that everyone has heart disease until proven differently with a calcium score of 0. In the absence of other risk factors, an elevated coronary artery calcium score is still the most predictive indicator we have for risk of coronary events. For many individuals, a coronary calcification score is the only indication that they are at higher than expected risk for a heart attack.
Why would I (or my doctor) want to know this information? What can be done?
The real question might be, why would you not want to know? The EBT heart scan is the most powerful tool in existence for the early detection of heart disease. We at Front Range Preventive Imaging want to help everyone discover their actual risk for heart disease, and help physicians take advantage of the results from thousands of patients who have benefited from early detection and proper medical management. But first, we need to know exactly who is at risk with early, accurate detection. Statistics clearly show that the conventional risk factors we are using miss more people at risk than they find.
I recently had a stress test that was perfectly normal but I have some coronary calcium on the EBT Heart Scan. Does that mean that this test or the stress test was wrong?
Neither. 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 flow in your heart. A coronary artery has to be at least 70% occluded or “blocked” in order for a stress test to show an abnormality.
The EBT heart scan is able to detect plaque long, long before plaque becomes problematic to the point where it blocks or impedes blood flow. Your heart scan tells us that the heart disease process has indeed begun, and there is an opportunity to make some life style modifications which will minimize or even remove 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 the EBT heart scan. The primary purpose of the heart scan is to detect disease long before there is any 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?
First, a Board Certified Radiologist examines the series of pictures obtained by the EBT scanner. He will verify the total amount of calcification (the ” calcium score”) present. The radiologist will also generate a second report referred to as a “Limited Chest”. In this he will report on anything thing he finds outside of the heart, for example in the lungs. Then, our Medical Director, who is a Board Certified Internal Medicine physician, reviews each report and comments on the overall significance and general recommendations for you, based upon your score.
The report is very thorough and very easy to understand. It will be useful to you and your doctor to review the recommendations for the management of any disease that is found. 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?
Absolutely! Contrary to what we have been led to believe, “normal” cholesterol numbers are by far, the weakest predictors of heart disease that there is. People die of heart attacks who have great cholesterol and some people with terrible cholesterol have no discernible coronary plaque on EBT heart imaging. If you rely solely on “good cholesterol numbers” as indicators of your risk for heart disease, your odds are very high that you will end up with a heart attack.
On the other hand, if you are taking a statin because of your “bad” cholesterol numbers, and you have an EBT heart scan calcium score of zero, you might discuss stopping your statin medication with your physician. The data clearly shows that with an EBT calcium score of 0, your risk of having an adverse event as a result of taking the statin is greater than your risk of having a coronary incident.
Should I obtain a physician referral for this test or should I make an appointment independently of my doctor?
This is a personal decision. A physician referral in not required. We, at Front Range Preventive Imaging, however, 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.
Many times, 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.