Learn which tests are necessary to measure the health of your coronary arteries and determine the heart attack risk.
Measurement of Central Aortic Pressure / Endothelial Dysfunction:
This is the one best indicator of high blood pressure that is now performed by cardiologists around the world. I have used a using a CASPro® machine in the past, which is an FDA-approved machine which has the sensitivity of 99% to correlate central aortic
pressure with cardiac catheterizations that were performed by an invasive cardiologist. The pressures in the central aorta are much more significant for mortality and morbidity, and recently, according to several studies, have been more-correlated with a longer
life. I perform this routinely in my office on patients that have hypertension. In addition, this test looks at endothelial dysfunction. As you age, the arteries become stiff, which begins the onset of coronary artery disease. If gotten early, this can be repaired
first with no traditional supplementation. If central pressures are high, I usually then add an ACE or ARB which is a type of blood pressure pill shown to decrease central aortic pressure. Of note, the older diuretics and beta blockers do not do this; therefore, I
prefer to use an ACE or ARB.
Electron Beam Computed Tomography:
This is a sophisticated, noninvasive screening procedure for measuring hardened plaque in the coronary arteries. It is also proven to be a reliable way to assess heart attack risks in people with no or few known risk factors. The amount of calcium in the coronary
arteries is certainly a risk factor. For example, measuring calcified plaque in the coronary arteries was shown to be a better predictor of substantial heart attack risks and than any other cardiovascular risk factors identified and the famous Framingham Heart
Study, which included high blood pressure, high cholesterol, obesity, cigarette smoking, diabetes and physical inactivity.
More specifically, research shows that a calcium score greater than 1000 places an individual at least at 75th percentile of risk, and perhaps in the 90th percentile or higher for sudden death due to heart attack. Although there has been considerable controversy of t
he significance of coronary calcification from organizations like the American Heart Association, I concur with the research cited above and strongly recommend it as a screening test for hidden, undiagnosed, or silent heart disease.
I consider anyone with a calcium score greater than 100 to be a concern. A person with a score of 100 is at least three times higher for the risk of sudden death than someone with a score of 0. A score of 1000 or more raises your risk to 12 times more than that
with a score of 0. This test is invaluable for people who have heart disease symptoms who could benefit from some improvement with lifestyle changes. Insurance may or may not pay for the scan, which is approximately $400 here in Scottsdale.
Cat Angiogram I have been doing more of these and find them very very useful in showing anatomical coronary blockages with very good accuracy
Carotid Artery Duplex:
Both carotid arteries can be visualized with sophisticated ultrasound screening as well as intimal medial thickness (IMT analysis). IMT is important in that it identifies those plaques, and it is one of the newer ways to predict heart disease, including sudden death.
A coronary angiogram or cardiac catheterization is the Gold Standard for evaluating the presence and the extent of obstructive coronary artery disease. This invasive procedure is done when you are awake, after a local anesthetic. Anesthetic is injected into the groin area to access the femoral artery, or the brachial artery in the arm. We only use this test after a noninvasive procedure indicates the need. Angiograms are also used to evaluate the heart valves, especially if surgery is considered.
Cardio Dx this is a new test to measure several cardiac genes to see if you are at risk for coronary artery disease Very accurate.
DEAN R. SILVER, M.D.