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In the News

 
'Ultrafast CT' with electron beam accurately predicts heart attacks in seemingly healthy people, study
 

DALLAS, June 1 -- "Ultrafast CT" scanning with an electron beam proved many times more powerful than the best available non-invasive test in predicting heart attacks and other coronary disease episodes, even in apparently healthy people, a new study shows.

By measuring the amount of calcium deposits that build up in coronaries -- in a disease process commonly called hardening of the arteries -- ultrafast CT accurately predicts cardiovascular disease events in people with no symptoms, doctors at St. Francis Hospital in Roslyn, N.Y., report in today's (June 1) American Heart Association journal Circulation.

"This is the first large, written report with a high degree of completeness of follow-up (99.8%) documenting the prospective short-term predictive value of EBCT (electron beam computed tomography) of the coronary arteries in asymptomatic patients," the team writes.

EBCT is a "tool that allows us to identify people who are at high risk for coronary disease," says Yadon Arad, M.D., the study's lead investigator and director of preventive cardiology at St. Francis Hospital. "EBCT screening would enable me to identify individuals in the early stages of coronary disease who would benefit the most from therapies (such as drug treatments, diet and exercise) that might prevent heart attacks."

EBCT scanning costs range from $375 to $500 in the United States, which is "relatively inexpensive, compared to other diagnostic tests used in cardiology," he says.

The researchers used EBCT in 1,173 asymptomatic patients between September 1993 and March 1994 and then followed the patients for an average of 19 months. During the follow-up, 18 patients had a total of 26 cardiovascular events -- including one death, seven heart attacks, eight coronary artery bypass surgeries, nine coronary angioplasties and one stroke.

"We conclude that EBCT-based screening for coronary artery disease shows great applicability to the development of cardiovascular disease events in a relatively short time period (average, 19 months) in a mostly middle-aged group that was 71 percent male," the investigators write in Circulation.

But Lewis Wexler, M.D., of Stanford University Medical Center in California, cautions that EBCT scanning is still undergoing clinical investigation. "As promising as the results of the study appear to be, it's still an experimental screening technique," he says. "Large-scale prospective studies are needed to prove its predictive value, which will differ depending on a patient's age, gender and the presence of coronary artery disease risk factors." Wexler chairs an AHA panel that is developing a scientific statement on coronary calcification and EBCT.

Alan D. Guerci, M.D., study senior author and director of research at St. Francis Hospital, says: "Our study shows that EBCT scanning of the coronary arteries has a predictive accuracy that exceeds by a large margin that of any other non-invasive technology,"

Although cholesterol testing involves drawing a blood sample, it's considered to be non-invasive, Guerci notes. But even the best cholesterol test (the ratio of total cholesterol to "good" HDL cholesterol) achieves an "odds ratio" of only about 1.6, he says. (An odds ratio of 1 implies no increased risk.) Guerci defines odds ratio as "the probability of getting sick or dying if your test result is abnormal, divided by the probability of something bad happening to you if your test result is normal."

His team found EBCT achieved odds ratios ranging from 20 to 35, making the scanning technique more than 10 times more powerful a predictor of coronary disease episodes than cholesterol testing, he says.

Autopsy reports and other data have consistently shown a correlation between coronary artery calcium content (CAC) and the severity of coronary artery disease, the authors note. EBCT provides doctors a CAC "score" for each patient based on the amount of calcium seen in the scans. Among study participants, CAC scores averaging 935 in patients with coronary events, vs. scores averaging 144 in patients without events. And those individuals with a CAC score above 160 had a 35-fold higher risk of developing a coronary event than those with scores below 160, the researchers found.

While this is the first published report of a follow-up of apparently healthy persons undergoing EBCT scanning of the heart, three other studies presented at two recent AHA scientific meetings had similar findings, Guerci points out. "Now there are four studies with a total of 2,745 asymptomatic patients and all four show the coronary calcium score is highly predictive of future cardiac events."

Because the coronary arteries supply blood to the cardiac muscle and are in constant motion as the heart beats, obtaining X-ray images of the moving vessels was difficult until the new superfast machines were built. Ultrafast CT devices using electron beams now are available in about 25 cities in the United States and about 30 cities in Europe and Asia.

Guerci emphasizes there's no link between calcium deposits in the coronary arteries and calcium-rich foods, or the calcium supplements taken by many older women. These women have a high risk of developing osteoporosis and "they should not lower their calcium intake because of our findings," he says.

Other co-authors with Arad and Guerci are Louise A. Spadaro, M.D.; Ken Goodman, M.D.; Alfonso Lledo-Perez, M.D.; Scott Sherman, M.D., and Gail Lerner, M.S.

Circulation is one of five scientific journals published by the Dallas-based AHA.

 
 
 
 
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