Cardiology is an area of medicine that has generally been focused upon the later, more deadly stages of disease, much like oncology (cancer medicine) used to be.  In the last 15 years, however, oncology has changed dramatically.  Finding cancer early, before it is too-late-to-cure, has become a national passion.  Screening for colon cancer, skin cancer, and breast cancer are all accepted as good medicine.  Clearly, finding those diseases early helps improve the survival prospects for the patient.  This is expected to be true of heart disease also.  Unfortunately, there has been no ideal test for cardiac screening purposes.  To be acceptable for this purpose, the test must be fast and easy for the patient - that eliminates the invasive tests such as angiography (cardiac cath) and intravascular ultrasound (IVUS).  A screening test must also be readily affordable - that eliminates all but the stress EKG (treadmill) test.  And finally, a screening test must also be very sensitive - that eliminates the stress EKG, at least for detecting early atherosclerosis.

Heartscoring:  Also called cardiac calcification scoring, calcium scoring, and heart scanning, this test has not been widely available. Although it has held the greatest promise as a true cardiac screening procedure, the cost of the equipment has been prohibitive.  Utilizing a special type of CT scanner called an electron beam CT (EBCT), it is possible to measure the calcified plaque in the coronary arteries, and get an indication of the total plaque burden. (This calcified plaque is the tip-of-the-iceberg where atherosclerosis is concerned.)   Moreover, because the overall amount of arterial plaque has been shown to be the single best indicator of cardiac risk, this information may prove to be ideal for screening purposes.

Below is a representation how different diagnostic procedures compare for cost, and sensitivity:

Recently, a breakthrough in technology was achieved which should allow heartscoring to become widely available.  The technology is a new hybrid type of CAT scanner called GHCT, and it is able to perform heartscoring as well as all other CT procedures.  Since a standard high speed CT system, as found at most larger hospitals, can be upgraded to this capability, access should no longer be an issue.

As you can see by the above chart, heartscoring is even more sensitive at finding early atherosclerosis than is coronary angiography.   This is surprising since angiography is the standard for visualizing arterial stenoses (narrowings).  The difference in sensitivity is explained by the fact that the arteries have the ability to expand as the plaque builds, in effect, compensating for the accumulation of plaque along the walls (up to 40% blocked by diameter), and resulting in little change to the opening of the vessel (lumen).  This phenomenon is called the Glagov Effect.  Angiography, or cardiac catheterization, does a wonderful job of assessing the lumen, but it can possibly result in the false impression that since there are no observable stenoses, there is no significant risk to the patient.  The presence of atherosclerosis, as determined by heartscoring, would indicate otherwise.  Moreover, addressing the disease early through risk factor modification and medicine may actually prevent the advent of a major stenosis for many years to come.

It is important to note that while heartscoring is excellent for screening purposes, it cannot demonstrate the vessel opening, nor is it useful for therapeutic applications, as is angiography.  Furthermore, as a screening test, a suspicious heartscore would routinely require confirmation by another non-invasive procedure.  If that secondary procedure also indicates a problem, then an invasive procedure such as angiography could be warranted.

The potential for heartscoring to be the answer to cardiology’s need for a good screening procedure has been demonstrated in scores of clinical papers.  (In fact, there are over 150 published studies on coronary calcification scoring.)  Increasing public awareness, and the ongoing education of the medical community should drive the acceptance of this new weapon in the fight against heart disease.

So the question is, who gains from screening for heart disease:

• Patients
• Primary Care Physicians
• Employers
• Insurers
• Cardiologists