Record Journal – Sunday, December 3, 2006
MidState’s CT scanner can provide valuable heart info
New machine can give invaluable information about your potential for heart disease
By Jeffery Kurz, Record-Journal staff

MERIDEN - Getting through the screening is about as easy as it gets. There’s no preparation required and it lasts just minutes. After connecting to a pulse monitor and sliding partway into a round opening in a squarish machine, all you have to do is hold your breath a couple of times.

From such a quick, simple set-up can come invaluable information about your potential for heart disease, the nation’s number one killer. While you’re holding your breath, cameras are taking multiple pictures of your heart - like X-rays, but much more detailed - and sending them to a computer, which is on the lookout for calcium.

Calcium built up on the walls of arteries indicates heart disease. Plaque built up over time can narrow arteries or stop blood flow from the heart. Calcium deposits are the hardening of that plaque.

From this simple test physicians can tell whether disease is present and how far along it is. Calcium deposits light up like tiny stars on the computer screen within the dark-andgray image of the heart. The computer also calculates the amount and renders a calcium score - the more detected, the greater the risk for heart attack. While that makes computer tomography scanning for heart disease a powerful tool, no test can stand entirely on its own as a screening device for heart attack. But Mid State Medical Center is viewing it as a significant addition to its heart-disease-fighting arsenal. If the screening does show disease, such a snapshot can be a strong influence on patients being urged to reduce risk factors. Those include smoking, diabetes, high blood pressure and high cholesterol. When a patient has his heart held in front of him, so to speak, it can be a powerful incentive.

A team approach

In embracing the technology, Mid State has formed a team around it that includes the cardiology and radiology Heart scans departments. Dr. Robert Golub, a cardiologist, and Dr. Holley Dey, a radiologist, gave a report on using CT scanning for the heart at Mid State’s annual meeting last month. A radiologist is an expert in acquiring and interpreting the high-quality images. The cardiologist can put the findings in a clinical context for the patient.

“We’ve just created a close relationship with them that will be very good for patient care,” said Dey.

“Having the technology is critical,” said Jeff Flaks, Mid State’s chief operating officer. “But having the physicians to use it appropriately is of greater importance.”

Flaks said he was “delighted” to see the departments working together so well “to develop our services.”

Scanning for calcium screening is a kind of light-duty use of the machine’s 64-slice capabilities. The 64-slice scanner, which Mid State started using about a month ago, produces remarkable three-dimensional renderings of the heart.

“That’s when we’re really looking at coronary disease up close and personal,” said Golub.

The key advantage is in the resolution, said Golub. “The 64’s just a fancier camera,” he said.

Or, as Rafi Muhammed, Mid State’s chief CT technologist, put it, the device takes a loaf of bread “and you end up with a Wonder loaf of bread - you can take out each slice and look at it.”

As the patient rests within the machine, multiple scanners on a rotating gantry spin around the body. While you’re holding your breath, you’ll hear some whirring and clicking. All those images give a picture of the inner workings of the heart as it moves through time.

“So this is a tremendous tool,” said Golub. “It’s not perfect and it’s important to mention that we treat human beings, not tests.”

Golub said Meriden’s hospital is a leader in using the sophisticated equipment, which costs up to $2 million.

“It’s outstanding technology,” said Flaks.

“From Mid State’s perspective, we are at the forefront of this,” he said. “It’s a wonderful asset for our communities.

“One more tool”

Searching the heart for calcium deposits is not for everyone. Young people with low risk for heart disease are not candidates, nor are older people who have other indications and don’t need a test to tell them they have heart disease.

But for some of those in between, the screening can prove useful and an important complement to other testing of the heart, such as stress tests.

That means those who have risk factors for coronary artery disease but have not experienced symptoms. The testing’s most often suggested for men 45 and older, and postmenopausal women 55 and older.

“It’s one more tool in the tool kit for cardiologists,” said Robert Townes, southwest Connecticut regional communications director for the American Heart Association. Townes called it a fast way to “detect whether they’re on the road toward coronary artery disease.”

There are caveats to CT scans for calcium deposits. While calcium is the evidence of chronic plaque, “what you don’t see is the earliest form, which we call soft plaque,” said Dey, which can also play a role in blocking arteries.

So a negative result on such a test probably ought not to be seen as a green light to head for the nearest fast-food joint.

“The calcium score is a tool for prevention,” said Golub. “It’s one piece of the puzzle.”

“That’s why we don’t treat tests,” he said. “We treat human beings.”