Throughout my medical career, advances in technology have led to remarkable advances in our ability to increasingly successfully manage previously confusing medical conditions. Recently, another step has been taken in the evolution of cardiovascular care.
Diagnosing coronary artery disease (CAD), the most common heart disease, just got a little easier thanks to technology that uses artificial intelligence to analyze cardiac computed tomography (CT).
CAD is the leading cause of death among Americans. Plaques, made up of calcium, cholesterol and fat, form in the coronary arteries – vital blood vessels that supply oxygen-rich blood to the heart. As plaques build up, they can obstruct blood flow and lead to heart attacks or debilitating symptoms such as chest pain or shortness of breath.
A CT scan uses computer-assisted X-ray technology to show images of the body as a series of “slices.” Using it to create diagnostic images of the heart and plaque is nothing new, but it has never been able to show us how badly a patient’s CAD has compromised their heart’s blood supply. To determine whether oxygen delivery to the heart has been compromised, doctors must measure fractional flow reserve (FFR), which is the maximum amount of blood that can flow through a narrowed artery compared to the maximum amount of blood that can flow through a healthy one. artery.
Before the advent of new technology, FFR had to be measured during cardiac catheterization. Although less invasive than other investigative procedures, cardiac catheterization requires a thin, flexible tube (catheter) to be passed through a blood vessel to the heart to diagnose or treat the heart and coronary arteries.
Fractional flow reserve computed tomography (FFR-CT) is a game changer. A diagnostic tool called HeartFlow Analysis uses artificial intelligence and highly skilled analysts to evaluate CT scan data of a patient’s heart and create a personalized digital 3D model of the patient’s coronary arteries.
With FFR-CT, there is no sedation or overnight stay, and doctors can easily obtain important information. The technology uses advanced computer algorithms to simulate blood flow so that cardiologists can assess the impact of CAD on blood flow to the heart with a non-invasive test. Cardiac catheterization is an effective procedure and continues to be the most appropriate technique for diagnosis and treatment of some patients, depending on their condition and health history. But it may also be unnecessary when CAD is not detected, and may precede additional tests and procedures.
The use of FFR-CT improves physicians’ ability to diagnose and treat patients for whom cardiac catheterization is not appropriate or necessary. For patients who need emergency cardiac catheterization, this can help avoid delays.
The benefit of FFR-CT to patients is clear. We now have non-invasive means of detecting and quantifying the severity of CAD. But there are additional benefits that go beyond treating the patient to better serve other patients and improve the quality of care.
This advanced cardiac CT scan reduces the need for unnecessary invasive procedures, limits unnecessary tests in the emergency department, and is consistent with the latest American College of Cardiology/American Heart Association Joint Committee on Chest Pain Guidelines.
We are also fortunate to have this technology to care for the communities we serve. FFR-CT is available at all Geisinger hospitals where cardiac CT is performed.
Dr. Alfred Casale, a cardiothoracic surgeon, is chief physician of Geisinger Surgical Services and chairman of the Geisinger Heart Institute. Readers can write to him at [email protected]