InTouch Magazine - Fall/Winter 2001

EBCT: The Latest Approach to Primary Prevention and Treatment of Heart Disease

Results from a major MHIF research study

Electron beam computed tomography (EBCT) is a highly sensitive and revolutionary new technology for the prevention and treatment of coronary artery disease. Electron beam CT is a state-of-the-art approach to cardiac imaging with exposure speeds more than 10 times faster than conventional CT scanning, allowing for accurate visualization of the heart. It produces thin section scans that are actually in synchrony with your own cardiac cycle, and is optimally designed to evaluate your cardiac anatomy in a single breath-hold.

Examples of Coronary Artery Scans

Normal

Moderate Calcification

Severe Calcification

"Early identification, evaluation and management of heart disease are major priorities for physicians and their patients,” says Thomas Knickelbine, M.D., who led the MHIF study on EBCT. "Moreover, the ability to determine which individual is at greatest risk is essential to appropriate primary prevention planning."

Although national guidelines have been formulated for cholesterol management and risk-factor-modification decision-making, clinical experience shows that conventional risk factors fail to predict up to one-third of future deaths due to coronary artery disease. In fact, 50% of the people who develop coronary heart disease present initially with a heart attack or sudden cardiac death and had no prior symptoms. Therefore, there is a dramatic need for cost-effective methods of coronary heart disease risk assessment that can be applied with confidence to primary prevention and treatment planning. "And this is where EBCT has become such an exciting and important technique," explains Dr. Knickelbine. "EBCT is the most sensitive approach available today to detect the existence, extent and density of coronary artery calcium and provide us with an effective calcium scoring, a valuable predictor of short- and longer-term cardiac events. It is the only technology that can non-invasively provide this critical evaluation."

In a recent three-part global review of their findings on more than 7,000 patients, Dr. Knickelbine and his colleagues addressed the results of their extensive survey, including how patients who had an EBCT scan changed their lifestyle; conducted a comparison of the calcium scoring and stress testing; and provided clinical follow-up with patients who had the scan.

Dr. Knickelbine emphasizes the following key points of the study:

• The EBCT test proved to be a strong motivator to affect positive lifestyle changes in patients (i.e., people reported a more healthy diet, more exercise and less smoking);
• Patients with very high EBCT scores were more apt to have an abnormal stress test, while those with low scores are very likely to be normal and probably don't need a stress test;
• If your EBCT scores show you to be in the very high percentile for your age and sex, you should consider an aggressive prevention program (including an LDL of less than 100), because you're a higher risk;
• If you have a family history of heart disease, are in the middle age range of 40-65 years old, and have one other conventional risk factor – you should discuss with your physician having an EBCT to help you determine more clearly your level of risk and best choices for prevention of heart disease. "This intermediate risk category is where we can make the greatest difference with EBCT and help patients define their long-term risk more clearly," says Dr. Knickelbine. “Waiting for symptoms of heart disease is not a reliable or wise approach."

Coronary calcium, as detected by EBCT scoring, represents a new and exciting tool for the physician and patient. It is the first and only current non-invasive technology to measure coronary artery disease. As such it can serve as a foundation to develop a strong, global primary prevention program – a vital component of the work of MHIF.

For more information about the study or about EBCT, please contact the staff at 612/863-3500.

This study was supported in part by a grant from the Ackman Family in memory of Lauress V. Ackman.