Throughout my medical career the progress in technology has led to remarkable advancements in our ability to deal ever more successfully with previously confounding medical conditions. Recently, there’s been yet another step in the evolution cardiovascular care.
Diagnosing coronary artery disease (CAD), which is the most common heart condition, just got a bit easier thanks to a 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 develop in the coronary arteries – vital blood vessels that deliver oxygen-rich blood to the heart. As plaques accumulate, they can obstruct blood flow and lead to heart attacks or disabling symptoms like chest pain or shortness of breath.
CT uses computer assisted X-ray technology to show images of the body as a series of “slices.” Using it to produce diagnostic images of the heart and plaque is nothing new, but it’s never been able to show us how severely a patient’s CAD has compromised their heart’s own blood supply. To determine if delivery of oxygen to the heart has been compromised, physicians need to 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 artery.
Prior to the advent of new technology, FFR had to be measured during a cardiac catheterization. While less invasive than other exploratory procedures, cardiac catheterization requires a thin, flexible tube (catheter) to be fed through a blood vessel to the heart in order to diagnose or treat the heart and coronary arteries.
Fractional flow reserve-computed tomography (FFR-CT) is changing the game. A diagnostic tool called HeartFlow Analysis uses artificial intelligence and highly trained analysts to evaluate data from a patient’s cardiac CT scan and create a personalized, digital 3D model of the patient’s coronary arteries.
With FFR-CT, there’s no sedation or overnight stay, and doctors can obtain critical information easily. The technology uses advanced computer algorithms to simulate blood flow, so cardiologists can assess the impact CAD has on blood flow to the heart with a non-invasive test. Cardiac catheterization is an effective procedure, and it continues to be the most appropriate technique for diagnosis and treatment of some patients, depending on their condition and health history. But it can also be unnecessary, when CAD is not detected, and it can precede additional testing and procedures.
Using FFR-CT enhances physicians’ ability to diagnose and treat patients for whom cardiac catheterization is not appropriate or necessary. For patients who need cardiac catheterization urgently, it can help avoid delays.
The benefit of FFR-CT to patients is clear. We now have a non-invasive means of detecting and determining the severity of CAD. But there are additional benefits that go beyond the patient being treated to better serve other patients and improve quality of care.
This advanced cardiac CT reduces the need for unnecessary invasive procedures, limits unnecessary testing in the emergency department and aligns with the latest American College of Cardiology/American Heart Association Joint Committee guidelines for diagnosing chest pain.
We’re also fortunate enough to have this technology to care for the communities we serve. FFR-CT isavailable at all Geisinger hospitals where cardiac CT is performed.
Dr. Alfred Casale, a cardiothoracic surgeon, is chief medical officer for surgical services for Geisinger and chair of the Geisinger Heart Institute. Readers may write to him via [email protected]