Diagnosing Coronary Heart Disease: A New Gold Standard?

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Heart disease such as suffered by President Bill Clinton earlier this year, should now be diagnosed more accurately and safely with the ultra-high CT speed scanner.

It is now known, that President Bill Clinton underwent several cardiac stress tests in efforts to determine the cause of his chest pain. After his last one, in September, 2004, he declared: “I aced it”. The next morning, we learned that his coronary arteries were 90% occluded. This scenario is not limited to the former President. In fact, it is quite common.

Even though President Clinton’s quadruple bypass surgery was successful and the prognosis for his recovery good, we should all be questioning the wisdom of cardiac stress tests as the first line of detection for coronary artery disease (“CAD”), a disorder that will affect 49% of American men, and 32% of American women at some point in their lifetimes, according to the American Heart Association.

Stress tests have been favored as a non-invasive method of testing for CAD. However, according to research performed by Dr. Daniel Berman, Director of Cardiac Imaging at Cedars-Sinai Medical Center, there is greater than a 50% chance of missing coronary artery disease (CAD) in high-risk patients who have undergone “normal” stress tests. His studies show that even severe CAD, such as that which occurred with President Clinton, can be missed by the stress test.

With the advent of non-invasive, ultra-high speed CT scanners, anyone can now be screened for the presence of calcium within the walls of the coronary arteries. The process takes minutes in the fully clothed patient, and is safer than a chest X-ray. The results indicate the degree of risk from suffering a heart attack if the condition goes untreated. Treatment or, prevention of progression, is now available for the full spectrum of this condition.

According to many scientists, the Electron Beam Tomogram (EBT), manufactured by General Electric Healthcare, is the current “gold standard” for CAD screening. “An EBT can scan the coronary arteries, and determine the presence of atherosclerosis far more accurately than the standard cardiac stress test,” said Douglas Boyd, PhD., the device’s inventor.

If calcium is detected in a non-invasive EBT scan, or if the patient is suffering from cardiac symptoms, the patient may be advised to undergo a coronary angiogram with the EBT which requires only an injection of dye into a vein in the arm. According to Dr. Boyd: “The EBT angiogram provides a 4-Dimensional (the 4th dimension representing “time”) roadmap of the interior of the coronary arteries, often finding obstructive disease that is missed by stress testing”. Dr. Boyd also points out that the EBT uses significantly less radiation than other forms of ultra-high speed scanning.

In former President Clinton’s case, even though he can afford the best medical care, his doctors relied on the standard stress test. In my opinion, a non-invasive, ultra-high speed alternative would have placed him at less risk, and possibly resulted in earlier recognition of his need for surgical treatment. In an era in which technology enables doctors to see 4-Dimensional images of the coronary arteries, doctors should change their mode of diagnosis to include the more accurate ultra-high CT scans. The public should be encouraged to include preventative scanning to detect potential disorders that can be prevented, reversed or retarded before the onset of costly complications.

Myles L. Saunders, MD is the Chairman & CEO of HealthAddress, Inc., a company involved in the interpretation of digital medical images including those taken by the EBT.

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Myles Saunders, M.D.
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