A Clearer Picture

Advances in coronary CT angiography (CCTA) over the past two decades have helped cardiologists detect heart disease in asymptomatic patients more accurately. Now, providers are using dedicated cardiac CT scanners to plan treatments and improve patient care. Innovations like the Arineta Spotlight Duo bring greater visibility than traditional 64-slice scanners, expanding what’s possible for providers and patients.

“CCTA gives us a much more global and comprehensive picture of what causes chest pain,” says Sujith Kalathiveetil, MD, a cardiologist at Duly Health and Care in the Chicago area. “It’s very sensitive and specific for detecting obstructive and nonobstructive coronary heart disease. We can also see other structures in the chest, like the aorta, so we can find other life-threatening causes of chest pain.”

Improving Cath Lab Function 

Since implementing a CT-first approach to diagnose coronary artery disease, Dr. Kalathiveetil has noticed shifts in referral patterns.

“Because CT is so sensitive and specific, there was a significant drop in our diagnostic catheterization, but we did see an increase in our revascularization numbers,” he says. “So, our interventionalists now spend far less time doing diagnostic caths, and the majority of cases they do, they’re performing intervention on.”

Cardiologist Jeffrey Boone, MD, says CCTA has improved collaboration between cardiologists and cath lab teams, with cardiologists using CT images to guide treatment planning.

“We’re on the phone with one of the best interventionalists, telling them where the plaque is, which plaque is most vulnerable, which one needs a stent, how much stenosis there is, what the valve looks like, and what other lesions look like,” says Dr. Boone, founder of the Boone Heart Institute, a preventive cardiology center in the Denver region. “It’s 30 minutes on the phone together with five or six doctors, and we know exactly what we need to do.”

Cardiac surgeons benefit from CCTA too, according to Dr. Kalathiveetil. “I’ve been able to convert most of them into ordering cardiac CTs on every patient they take to the operating room, for whatever reason,” he says. “I tell our surgeons, the CT is like having a roadmap before you walk into a minefield.”

 Tracking Disease Progression  

In Florida, cardiologist Alberto Morales, MD, with South Tampa Cardiology, is using CCTA for serial surveillance imaging, tracking heart disease in patients in the months and years following their initial diagnosis.      

“I have a registry of over 10,000 patients, most of which are asymptomatic, most of which have serial surveillance imaging,” he says. “We are tracking disease progression, regression, and stabilization through medical management. We’re also collecting many metrics, trying to define the phenotype—why these subsets of patients respond to aggressive therapy whereas others continue to see progression—and what the treatment options to improve those patients and cause regression are.”            

Exploring New Treatment Options     

Inside cardiology practices, CCTA is allowing providers to expand their services and pioneer new research. At Duly Health, Dr. Kalathiveetil has established the Cardiac Evaluation Center, an urgent care center for heart disease.      

“Our intake staff has a screening questionnaire for how to evaluate patients with chest pain,” he says. “As long as they don’t have any life-threatening features, they come to our center, have blood tests to make sure they’re not having a myocardial infarction, and assuming they’re not, they have same-day coronary CTA performed, as well as a consultation with a cardiologist.”      

At Boone Heart Institute, Dr. Boone is conducting three Heartflow-funded research projects, known as GAMEFILM, that use CCTA and AI to evaluate heart disease in former NFL, NHL, and NBA players. “The first abstract of the NFL project has been accepted for presentation at the upcoming ACC meetings in New Orleans,” he says.      

But perhaps the biggest benefit of CCTA in patient care, Dr. Morales reasons, is being able to sit down with patients and show them the results. “I find when you can show a patient their arteries, it changes their behavior,” he says.