Coronary calcium scan may be important tool in identifying Type 1 diabetics who are at high risk for heart disease

August 23, 2000

LOS ANGELES (August 24, 2000) -- According to a report in the American Hospital Association's "News Now," new research at the University of Pittsburgh indicates that a heart scan using electron beam computed tomography (EBCT) may be an important tool in finding Type 1 diabetics who are particularly high heart disease risks.

According to the study, which will appear in the September issue of Diabetes, a journal of the American Diabetes Association, EBCT provides a fast, non-invasive way to identify and measure calcium build-up in the arteries leading to the heart.

According to Daniel Berman, M.D., Chief of Cardiac Imaging in the Department of Imaging at Cedars-Sinai Medical Center, the findings are significant because this is the first reported use of the EBCT to identify people with Type 1 diabetes at high risk for heart disease.

Although we have been successfully using the EBCT technology in our Heart Watch program since 1998, these new findings are very significant for patients with Type 1 diabetes," said Dr. Berman. "Heart disease is the number one cause of death in Type 1 diabetics, occurring at more than five times the rate of the general population."

In 1998, Cedars-Sinai launched Heart Watch, a new cardiac program that features a coronary calcium scan. The high-tech EBCT scanner, made by Imatron, Inc., is highly advanced and has no moving parts. It uses an electron gun with a sweeping beam, and is able to detect very small amounts of calcium in artery walls.

"What this means," says Dr. Berman, "is that patients who are at risk for coronary heart disease -- the number one cause of death in both men and women in America -- can now be identified much earlier. And that means that treatment planning, lifestyle changes, and other interventions can begin much earlier -- when they are most effective."

"Fifty percent of people with heart disease do not know they have problems until they experience an event with irreversible damage or even death," says Dr. Berman. "While we have recently seen multiple major breakthroughs in the medical treatment of coronary artery disease, the key to effective treatment is early identification of patients at-risk, before they experience a damaging episode, so as to begin a specific treatment plan most appropriate for them." The Heart Watch Coronary Calcium Scan provides the earliest definite detection of coronary artery disease."

When standard methods of detecting coronary artery disease are used, the disease process has to be severe enough to impede blood flow before it can be identified. "In contrast," says Dr. Berman "the Heart Watch Coronary Calcium Scan identifies small amounts of calcium in vessel walls (calcium is what is responsible for the 'hardening' in the process of hardening of the arteries or arteriosclerosis). The EBCT scanner can detect calcium deposits long before they are large enough to form an obstruction in a coronary artery. This, in turn, enables physicians to implement specific treatment plans much earlier than in the past."

Just as important, the technology enables physicians to follow patients over time, tracking the progress of the disease (or hopefully its lack of progression) under treatment, and facilitating appropriate change in treatment for patients in whom the disease process appears to worsen.

According to P.K. Shah, M.D., Director of Cardiology at Cedars-Sinai, the arrival of the Heart Watch Coronary Calcium Scan offers a unique opportunity for collaboration between the Imaging and Cardiology departments, with unprecedented clinical, research and preventive applications. Although the scanner will be also be used for non-cardiac imaging, its primary purpose at Cedars-Sinai will be to identify, non-invasively, plaque build-up in the coronary arteries of patients, thereby enabling physicians to better predict the risk of future heart attacks and institute preventive measures.

Although the noninvasive technique is promising for early detection of coronary artery disease, more research is necessary to fully define the ultimate role of this new technology and its impact on patient outcome. The Department of Imaging and the Cardiology Division are collaborating in a research program on subjects undergoing the Heart Watch Coronary Calcium Scan which will include a battery of sophisticated blood tests to determine their added value for predicting the risk of future heart attacks. "While it is unlikely that the Heart Watch Coronary Calcium Scan will replace existing techniques, it will most certainly complement them," says Dr. Shah.

Similar in concept to a conventional CT scanner, the EBCT scanner offers clearer imaging of the heart. Conventional scanners need time to rotate mechanically around the patient, resulting in blurring of cardiac images due to heart motion. In contrast, with the Ultrafast EBCT scanner, only an electron beam sweeps around the patient, so those three-dimensional images can be taken in 1/20 of a second -- 20 times faster than conventional CT scanners. This extremely high-speed beam results in 'stop-action' three-dimensional images with unparalleled clarity.
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Cedars-Sinai Medical Center

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