Bonus Q&A following cardiac imaging webinar

Bonus Q&A following cardiac imaging webinar

After our webinar, 'Heart-to-Heart: Your Cardiac Imaging Questions Answered,' which was recorded on February 22, 2024, I-MED Radiologis, Dr Ken Sesel has addressed several additional questions submitted by our attending GPs during the session.

You can watch this video, and our other cardiac imaging presentations here.

When referring for a CACS, what information is required on the referral? Is writing 'cardiac risk assessment' sufficient justification? keyboard_arrow_down

No specific requirement except to request CACS.

With the cost of a private Cardiac MRI comparable to that of CTCA, can MRI be considered good alternative for CTCA? keyboard_arrow_down

No, it is not. Currently, MRI is not a suitable alternative for examining coronary arteries based on existing technology.

Should a statin be prescribed for a 60-year-old asymptomatic caucasian male with type 2 diabetes and a coronary artery calcium score (CACS) of zero? keyboard_arrow_down

While a CACS of zero indicates a low statistical risk, it does not rule out the presence of soft plaque. If soft plaque is detected, would you recommend treatment?

At what age would we use calcium score as a screening tool? keyboard_arrow_down

The recommended age thresholds are 42 for men and 58 for women. It is important to exercise caution when interpreting low or zero scores in younger age groups, specifically those under 50 for males and under 60 for females (source:

If a patient has a CACS of zero or a low score, how can I assure them that their risk is minimal, considering that soft plaques, which may lead to sudden death, are not detected by CACS? keyboard_arrow_down

To provide reassurance, use the calculator to offer a statistical risk assessment. It can only estimate the probability of an event occurring in the next 10 years. Like blood tests, CACS is a risk score, specifically measuring "healed plaque" and may not detect significant soft plaque.

Can unstable plaque be easily identified with CTCA? keyboard_arrow_down

CTCA is the holy grail of coronary imaging in non-invasive techniques for this purpose. However, it's essential to note that achieving accurate results with CTCA relies heavily on the use of high-quality equipment and the expertise of the healthcare professionals conducting the procedure.

Is it worth continuing statin in people aged 70+ who are high risk? keyboard_arrow_down

Yes, it is recommended. If the initial CACS is zero, consider a repeat assessment in 3 to 5 years to ascertain if the risk remains low. If a CTCA is normal, then consider discontinuation of statins.

55yo asymptomatic patient, already taking statin due to elevated lipids, borderline HT and strong family history of early CVD. Is there any point in doing either a CACS or CTCA if the statin is well tolerated, and the patient is happy to continue treatment? keyboard_arrow_down

If the patient has a significantly high CACS or CTCA showing severe soft plaque, would you change the medication? 

A potential course of action may involve lipid-lowering therapy and implementing improved lifestyle management. Additionally, ensuring better medication compliance could be crucial. Referral to a cardiologist may be warranted, along with the initiation of functional tests to elicit any borderline or subclinical symptoms.

What is the timeframe or "use by date" for coronary CT angiography (CTCA) in terms of remaining confident that vessel disease burden is low? keyboard_arrow_down

If the CTCA results are normal, the confidence in a low vessel disease burden typically extends to five years, considering the high negative predictive value of 98-99%. In cases where non-obstructive stable-looking disease is identified, a shorter interval of three years is suggested. However, the decision on whether to pursue early follow-up, correlative stress testing, or catheter angiogram should be guided by an expert interpreter. Absent specific recommendations, the focus should be on medical treatment and preventative management.

Is there a role for repeating a calcium score in someone who has a score of 50-100 to assess disease progression? keyboard_arrow_down

In cases where the first CACS is zero, it is advisable to repeat the assessment in 3 to 5 years to gauge whether the risk remains low or if there has been any progression in disease.

Is there any medication that increases Calcium score? keyboard_arrow_down

No specific medication is known to increase coronary artery calcium score (CACS). However, treating the underlying disease may contribute to stabilising the amount of soft plaque. It's important to note that CACS tends to increase with age as plaque heals and undergoes calcification.

Is there still a significant incidence of false positives in current CT angiography? keyboard_arrow_down

A positive result in CT angiography is generally considered to be less reliable than a normal study. The positive predictive value can fluctuate based on factors such as the volume of cases handled by the site, the technology used, and the expertise of the interpreter. For instance, in a high-volume site, the positive predictive value may range from 70% to 80%.