| Newport Daily News
NEWPORT – Five to 10 people a day come into Newport Hospital who say their chest is bothering them, according to Dr. Joseph Weiss, a cardiologist at the hospital,
“In some cases doctors quickly determine coronary disease,” Weiss said. “But there is a large group of people where we are not certain.”
When arteries leading to the heart narrow or become blocked, blood flow to the heart may be reduced, causing chest pain and potentially fatal heart attacks. Coronary artery disease is the leading cause of death for both men and women in the United States.
Weiss and Dr. Jason Vachon, a vascular radiologist at the hospital, work together with a new diagnostic tool called HeartFlow Analysis that is used for determining whether a patient has heart disease and the extent of it.
It is a supplement to the computed tomography (CT) angiograms that use X-rays to create detailed pictures of the heart and its blood vessels. Computed tomography angiography (CTA) has been used in hospitals and around the country in recent decades.
What the new HeartFlow Analysis does, is take a patient’s data from the noninvasive coronary CTA and create a digital 3D model of the coronary arteries. The analysis uses artificial intelligence and computer algorithms to simulate blood flow and assess the impact of blockages on the heart.
“They are amazing pictures,” Weiss said. “They are just phenomenal.”
Newport Hospital is the first hospital in Rhode Island to use HeartFlow Analysis. It was introduced in early 2020, but with all the attention on the deaths and impacts caused by COVID-19, it has flown under the radar like so much else.
Because February is the 57th annual American Heart Month, Weiss and Vachon took the opportunity to talk with the Newport Daily News in a Zoom interview about the new state-of-the heart technology that they want more people to know about.
“The key here is the collaboration between the cardiologists and the radiologists,” Weiss said.
“Typically the CT scans are read almost entirely by the radiologist,” Vachon said.
With HeartFlow, the heart portion of the exam can be read by a cardiologist with additional training.
“It makes sense to have cardiologists on board reading these as well as radiologists,” Vachon said.
“Cardiologists have much more understanding of the physiology of the heart,” Weiss said. “We benefit from each other when we are able to look at these exams together.”
When patients have symptoms like chest pain or shortness of breath, the traditional approach is to give them a stress test.
“We put them on a treadmill, look at their EKG, their echo cardiogram and try to determine if there is inadequate blood flood to the heart as the basis for the symptoms,” Weiss said. “That is still a widely used approach, but it has some problems.”
“First, there are a lot of people who can’t walk on a treadmill, especially elderly people who may have orthopedic problems or who can’t cope with that,” he said. “Another problem with stress testing is that we are often dealing with false negatives. We may have a problem like a narrow artery that is below the threshold of detection by conventional stress testing.”
Sometimes the stress is inadequate or there is some other reason for not detecting the low blood flow.
Invasive angiography is when doctors put a tube into the radial or femoral artery and advance it to the heart and inject contrasts so the doctors can see the arteries, Weiss said.
“That’s the most definitive test,” he said. “It has some potential risks involved. When you are putting tubes into people’s hearts, things can happen,”
“If you having an invasive angiogram, you have to go up to Providence and it can take hours to days to get it done,” Weiss said. “There is also more radiation involved with the X-rays used.”
Of course if action is necessary, balloons or stents can be inserted in the arteries.
When CT angiography was developed, the invasive techniques were not required in many cases, but it had problems, Weiss said.
It was so sensitive that a lot of arteries looked diseased, he explained, But when the doctors did a definitive test like invasive angiography, it turned out there was not a big problem. The CTA test was not specific enough.
What HeartFlow does is address that problem, Weiss said.
“It takes pictures of arteries and tells us what the functional significance is,” he said. “So we’re moving from structural information to functional information. In doing so, we are getting rid of false positives and increasing specificity.”
HeartFlow uses very advanced computer algorithms to look at flow dynamics to measure flow across coronary arteries to determine whether or not a blockage is significant and whether further intervention is required, Vachon said.
The CT angiogram with the linked HeartFlow Analysis can be done at Newport Hospital within an hour or two of a patient’s arrival in the emergency room.
There are several known risk factors that can lead to cardiac disease. Age is becoming an increasing risk factor as people are living longer, but there are also high blood pressure, diabetes, smoking, bad cholesterol, inflammation, and family history.
“I think we understand about half of what causes heart disease,” Weiss said. “There are large population-based genetic studies that have identified about 170 genes that contribute to heart disease. When we look at the function of those genes and try to relate them to our known risk factors, only half of them can be connected. That implies that there are processes taking place that were not aware of that we can’t measure and that contribute to heart disease.”
The role of opening arteries has gotten very complicated. Weiss said.
“It turns out unless you are about to have a heart attack, the benefits of opening an artery of somebody with stable symptoms are not as great as we thought,” he said.
People can be treated medically to relieve symptoms in some cases instead of invasive procedures involving opening up arteries to increase blood flow, the doctors said.
HeartFlow Analysis is helping to make the right decisions.