Heart Scan - Know Your Risk
EBCT - When To Obtain A Heart Scan And How To Interpret Your Score
Heart scanning is rapidly evolving from a luxurious peek inside the heart into a critical tool preventing thousands of cardiac deaths worldwide.
EBCT (Electron Beam Computerized Tomography) or CT Heart Scanning has been available to the general public in the United States for over 20 years, allowing patients to take a proactive approach in assessing their individual risk of future cardiac events. Not only useful as a tool for those of moderate age, a recent study published in the American Journal of Cardiology reinforced the usefulness in utilizing the coronary calcium score as a significant predictor of stroke for adults over the age of 70.
Yet another study, published in the New England Journal of Medicine (March 27, 2008), confirmed the strong predictive value of coronary calcium scoring across races and ethnic backrounds (white, black, hispanic and chinese) within United States populations.
The numbers of patients requesting these scans is increasing nationally at a rapid pace. “Our patient load has steadily risen and we project an exponential increase in patient volume over the next five years” states Dianne Mehsling a RT/CT Technologist at Front Range Preventative Imaging in Boulder, Colorado.
Who Should Consider A Heart Scan?
Although a medical referral is not required for a heart scan, the American Heart Association currently recommends EBCT as helpful for those in the “intermediate or moderate” cardiac risk category. A risk assessment tool is available online at the American Heart Association website.
In analyzing risk, the following factors should be considered in conjunction with a physician:
- Medical history
- Family history
- Physical exam results
- Blood pressure
- Smoking history
- Exercise history
- Physical symptoms
- Blood work with cholesterol
Who Should Not Consider A Heart Scan?
Medical experts generally advise that those with the following conditions should not self refer to a heart scan center as they are already under aggressive care or preventative programs:
- Patients who have had a heart attack
- Patients with a history of coronary artery bypass graft procedure
- Patients who have had angioplasty with or without stent placement
- Patients with a high risk of heart disease
Although these patients are not advised to self refer, a physician may choose to utilize heart scanning to supplement the patient care planning and assessment.
What Exactly Is a Heart Scan?
- Heart scan is a rapid, non invasive CT scan that gives the patient and the physician the ability to look for calcium deposits and blockages in the coronary arteries of the heart.
- The patient is provided with a “score” (coronary calcium score) at the conclusion of the test which indicates the risk of coronary events within the next two years.
- The calcium this test scores is an element of plaque (along with fat and cholesterol) that clogs or narrows coronary arteries, a precursor to heart attack or stroke.
How Is a Heart Scan Performed?
- There is no pre-test preparation.
- There is no sedation necessary.
- Many centers do not require a change from street clothing (although some may require undergarments with wiring to be removed).
- A few electrodes are placed on the chest.
- Time in the CT scanner is approximately 5 minutes; communication with staff is constant and ongoing.
- Test results are reviewed by the technologist, radiologist and medical directors and are provided usually within one business day directly to the patient (with copies to the patient's physician if requested).
What Are the Costs And Are They Covered by Insurance?
- Costs generally range from $350 to $700 across the United States but continue to decrease.
- Insurance coverage varies with the patient plans and generally are not covered.
How Are The Results Reported?
- The patient receives a report indicating the coronary calcium score.
How Do I Interpret My Coronary Calcium Score?
- 0 - No plaque is present. There is less than a 5% chance of having heart disease. Risk of a heart attack is very low.
- 1 – 10 - A small amount of plaque is present. There is less than a 10% chance of having heart disease. Risk of a heart attack is low.
- 11 – 100 - Plaque is present. There is mild heart disease. The chance of a heart attack is moderate.
- 101 – 400 - A moderate amount of plaque is present. There is heart disease; plaque may be blocking an artery. The chance of a heart attack is moderate to high. Your health professional may want to do more tests and may start treatment for heart disease. Aggressive treatment may be started for risk factors such as high blood pressure and high cholesterol.
- Over 400 - A large amount of plaque is present. There is more than a 90% chance that plaque is blocking one of the arteries. The chance of a heart attack is high. Your health professional will want to do more tests and will start treatment.
What Are The Risks Of Having A Heart Scan?
- Critics raise the issue of false negative results in heart scanning especially in younger populations. A negative result may not detect soft plaques.
- Although calculated risk is present, actual risk (of course) cannot and is not and must be assumed as such. Critics note that further invasive tests may be performed (cardiac catherization and/or angioplasty).
- CT scanning increases radiation exposure comparable to multiple chest x-rays.
What Are The Benefits?
- Knowing your risk.
- Dependent on the results, identifying the risk of cardiac event in the immediate future spurs lifestyle changes and fosters a proactive approach by both the patient and the physician towards targeted medical prevention and/or timely intervention.
References: American Heart Association, Mayo Clinic
