EBT heart scan improves early detection of disease

Leonard Velick should be dead today. Instead, he’s playing tennis four times a week, golfing once a week, walking daily and biking and hiking all over the place. Not bad for a 69-year-old.

Eight months ago Velick was doing all those things, too, but with an artery next to his heart that was almost completely blocked. And he had no idea. And after two tests in February, neither did his doctor, Jamie J. Doucet, at the Colorado Cardiovascular Center.

“They did a blood test, it came back clear. They did a stress test, perfect,” Velick said.

“Dr. Doucet wasn’t satisfied. He told me with my family history (Velick’s father died at age 47 of a coronary thrombosis) and my history of smoking (Velick used to smoke cigarettes and was a current pipe smoker) that there had to be a something he wasn’t seeing,” Velick said. “So he gave me a third test – a new kind of heart scan that took just 15 minutes. It was noninvasive, and I didn’t even have to take off my shirt.”

Velick said he was in a hurry to get to a tennis match and left without learning the scan results, which rates the amount of blockage in arteries with a numeric score – the lower the better.

“Dr. Doucet told me if I scored over a 500 he would own me, as I was running out the door,” Velick recalled.

When Velick got home from his tennis match he learned he had scored a 1,690. In essence, he was a walking dead man. He could have dropped at any time.

On March 17 Velick underwent a quintuple bypass surgical procedure that improved the blood flow to his heart with five new routes, or “bypasses,” around the clogged sections of his arteries. Within eight weeks he was back on the tennis court.

Looking back, Velick explains that he really had no symptoms except that he was tired after playing two hours of strenuous tennis. Nothing strange about that – he was, after all, in his late 60s.

“I just thought I was getting old,” Velick said. “Now I don’t get tired anymore.”

Velick is one of many people who’s thankful for the EBT (electron beam tomography) heart scan, an ultrafast CT (computed tomography) scanner that takes a three-dimensional image to show any plaque in the coronary arteries.

The technology can quantify how much calcium is present in the arteries and give doctors a “calcium score,” which, according to Dr. Bill Blanchet, medical director of the Front Range Preventative Imaging in Boulder, is the strongest predictor of heart attack risk.

Speed also plays a role in these new EBT scans. Blanchet said normal CAT (computed axial tomography) scans create images by rotating an X-ray tube around a patient, but they need a quarter of a second to take an image. “In 0.25 seconds, there is significant cardiac motion; in 0.1 seconds, the heart can be caught with no discernable motion,” Blanchet said. “The EBT technology can take an image in 0.1 seconds – the fastest CAT scanner available.”

Blanchet added that EBT coronary calcium scoring is 17 times more predictive of who will and who won’t have a heart attack than all of the other risk factors combined.

Experts say that one out of three Americans will die from heart disease. And for 50 percent of victims of heart disease, the first symptom is a heart attack. For one-third of the victims of heart disease, the first symptom is sudden death. And 30 percent of the people who will die from heart disease have no risk factors for heart disease.

Blanchet said stress tests show up positive when the coronary artery is blocked 70 percent or more.

“Most heart attacks occur as a result of plaque fracture of a blockage of less than 50 percent,” he said. “Most people with heart attacks would have passed a stress test two weeks before their event.”

The scans cost from $395 to $495, and Velick said Medicare did not cover the cost of his scan.

“Medicare will pay for Viagra, but it won’t cover EBT scans,” Velick said. “Can you believe it?”

Blanchet says many insurance companies do cover the scan, but that most health maintenance organizations do not.

“I think as the clinical utility of this test is better understood by physicians and insurance companies, insurance coverage will improve significantly,” Blanchet said.

Doctors say the scans are best applied to men over age 40 and women over age 50 who have an average risk, and 10 years sooner for those with a higher risk.

“Women have just as much coronary artery disease as men do, but it tends to show up 10 years later,” Blanchet said.

Blanchet said the technology, which is sometimes called the mammogram of the heart, was born in 1983 at the University of California at San Francisco when doctors discovered that patients who died from coronary artery disease always had calcium in their vessels.

“That led to the development of a scanner fast enough to image moving tissue with minimal motion artifact,” Blanchet said.

Imatron, a company in San Francisco that’s now owned by General Electric, developed clinical applications that continued to be refined and entered the clinical arena in 1996, when the first study was published showing that calcium scores predicted heart attacks.

Blanchet said the technology has continued to be refined, and hundreds of studies have been published documenting its clinical value.

Experts say the scan is especially helpful for people with a history of heart disease in their family. Velick fell perfectly into that category. How’s he doing today?

Velick said he feels great, and that all his creditors are happy.