Heart Scan Frequently Asked Questions

My doctor has never told me about this procedure...why?
Electron Beam (Ultrafast) CT is a relatively new, highly specialized and sophisticated imaging tool mostly located at major university hospital centers around the world (Mayo Clinic, Baylor, UCLA, etc.) Its arrival in Denver in 1998 at Colorado Heart and Body Imaging, represented the very first center in our Rocky Mountain region. Front Range Preventive Imaging now brings this remarkable technology to the areas north of Denver. There are now hundreds of published papers and numerous textbook chapters concerning coronary artery calcification and its importance as it relates to electron beam CT. Your physician may not be familiar with the latest studies proving the value of this technology.

If it is new to this region, then how can the results be understood?
Fortunately, there is a great worldwide experience with this scanner, and its accuracy and predictive ability have been proven in numerous scientific papers. We, at Front Range Preventive Imaging have access to the results from thousands of patients studied throughout the world so we can best match your score with others by age and sex. It has become clear that most patients develop some degree of atherosclerosis as they get older, and this instrument is the only way to determine if an apparently healthy person has begun the process at above or below the expected rate.

What is the significance of calcification and the Coronary Artery Calcium (CAC) score?
Coronary calcification is a marker for coronary plaque and typically appears years before the development of symptoms of heart problems. This is truly "hardening of the arteries". The score that you receive represents the total amount (based on size and density) of the calcium deposits found in all of your coronary arteries. For all age groups, the higher the score, the more coronary disease is present and the greater the likelihood that it may result in a heart attack or chest pain in the future, if left untreated. Most men of over the age of 40 and women over 50 will have some degree of calcification, so do not be alarmed if your score is not zero.

My doctor told me that worrisome plaque is often non-calcified...but aren't you only measuring the calcified plaque?
That is correct. There are no current noninvasive methods that will identify all plaque. However, the calcified portion (measured by ultrafast CT) is a useful marker for total plaque. There are numerous studies in the medical literature that have shown the relationships between calcified plaque and total plaque. Calcium is important because it signifies the "tip of the atherosclerotic iceberg". The calcification score, correlates remarkably well with one's individual risk for a heart attack. Several studies show that the calcification score is a better predictor of a heart attack than a coronary angiogram.

I have no major risk factors for heart disease, I exercise regularly and I am very careful about my diet. Does the test have the same value for me?
In the absence of other risk factors, an elevated coronary artery calcium score is still very predictive for risk of a future myocardial infarction. For some individuals, a coronary calcification score is the only indication that they may be at higher than expected risk for a heart attack.

Why would I (or my doctor) want to know this information? What can be done?
We currently have powerful tools for preventing the progression of coronary artery disease in individuals with early disease. We at Front Range Preventive Imaging want to help your physicians take advantage of the results from thousands of patients who have benefited by these management strategies...but first we need to know exactly who is at risk.

I recently had a stress test that was perfectly normal but I have some coronary calcium on the ultrafast "CardioScan" test. Does that mean that this test or the stress test was wrong?
No. Although both tests were looking for heart disease, they are doing it in different ways. Your normal stress test indicates that the plaque buildup which was seen on the heart scan has not yet reached the point where it is interfering with the blood supply to your heart. Your heart scan tells us that the process has indeed begun, and there is an opportunity to modify all controllable risk factors to minimize the chance that you'll ever have a heart problem.

Can you tell me how much blockage there is in my coronary arteries?
Although it is possible for us to make some generalizations about the degree of coronary narrowing that likely exists, it is not a primary purpose of this test. The primary purpose of the test is to detect disease before there is much narrowing. Doctors now know that more than half of all heart attacks occur at sites of less than 50% narrowing. No other noninvasive test in cardiology can detect this type of early disease.

What kind of report will be created based upon my score?
A board certified cardiologist or internist and a technologist will examine the series of pictures obtained by the scanner and calculate the total amount of calcification (the " calcium score") present. From the information available, we will report the location and degree of anatomy may be recorded. A further cardiology panel report will also be included revealing the overall significance and general recommendations based upon your score. The report will be useful to you and your doctors to review recommendations for management. Ultimately, your personal physician (not Front Range Preventive Imaging) will be the best individual to determine the proper course of action for you. We are always available to you and your doctor for consultation.

I have a normal cholesterol reading. Can I still have coronary disease?
Having normal cholesterol puts you at a lower risk than average for heart disease. However, over 50% people with coronary artery disease have average cholesterol. It is now clear that some people with average cholesterol need further lowering by medications or diet.

Should I obtain a physician referral for this test or should I make an appointment independently of my doctor?
This is largely a personal decision. We, at Front Range Preventive Imaging believe that it is much more likely that the information provided at our center will be best utilized if your personal physician is aware of the test results. In general, a well read physician is best able to understand the overall importance of this test in the context of your medical history and physical exam. Your doctor may also have access to other important medical records that could help in the overall assessment of your situation. In addition, it is more likely that insurance companies will participate in the reimbursement of this procedure with an appropriate physician referral. In the majority of circumstances, the general recommendations on therapy or further testing will necessitate physician involvement and review of our findings. Some patients would rather keep the information confidential to all entities (including their doctors) and we respect those wishes.