Radiologists and heart specialists are developing new ways to identify heart disease through imaging.
Listen in as Dr. Christopher Kramer, a UVA specialist, talks about the latest advances in radiology and cardiovascular disease.
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Advances in Heart Imaging
Featured Speaker:
Dr. Christopher Kramer
Dr. Christopher Kramer is board certified in internal medicine and cardiovascular diseases and serves as director of UVA’s Cardiovascular Imaging Center. Transcription:
Advances in Heart Imaging
Melanie Cole (Host): Radiologists and heart specialists are developing new ways to identify heart disease through imaging. My guest today is Dr. Christopher Kramer. He is board certified in internal medicine and cardiovascular diseases at the UVA Health System. Welcome to the show, Dr. Kramer. Speak about, what imaging tests are used to diagnose certain heart conditions and how easy is this process?
Dr. Christopher Kramer (Guest): Thank you for having me, Melanie. There are actually five different tests that we use on a daily basis to evaluate heart conditions, and they all have their individual strengths and applications that we use them for. We can discuss each of them in turn. The most commonly used heart test is echocardiography or ultrasound to image the heart. It is frequently used to assess the function of the heart muscle as well as the function of the heart valves. It is frequently used to screen patients for the first time who may present with shortness of breath and to look for reasons why they may be short of breath, whether there is a problem with the heart function, cardiomyopathy, or problem with a heart valve, either it’s blocked or leaky. That’s the most frequently used reason for echocardiography or ultrasound of the heart. Another commonly used heart imaging test is SPECT, which stands for single-photon emission computed tomography. It is a nuclear technique that involves taking images of the heart and looking at blood flow to the heart muscle. This is very commonly used to again assess blood flow in a stress test. Typically, a patient will walk on a treadmill until they’re exhausted and can get no farther and we will image the patient with SPECT at rest and after stress to look for problems with blood flow to detect blockages in the heart arteries that might lead to reductions in blood flow. That’s a very commonly used cardiac imaging test. A relative of SPECT is a test called PET or positron emission tomography. It is somewhat less used. It is, in a sense, a better version of SPECT, but it is more costly and less available. It is used to again detect abnormalities in blood flow, but is much more quantitative than SPECT. It’s particularly used in certain types of patients, especially those who are on the obese side. Another commonly used cardiac imaging test is MRI of the heart. MRI is a newer test that’s only been available the last 10 or 15 years in heart patients and it is used both for stress testing, but not with an exercise treadmill. For this, we’d use an infusion of a medication that simulates the effect of exercise on the heart and we measure blood flow. In addition, MRI is often used in patients who have reduced heart muscle function or cardiomyopathy, because its best indication is really to understand what has caused the heart muscle to decline in function. That’s a very common use of MRI in 2014. Lastly, a very exciting cardiac imaging test is computed tomography or cardiac computed tomography or CT. CT is an anatomic test. Many of the other tests we’re talking about assess the function of blood flow. CT is really best at imaging the anatomy of the coronary arteries. It gives us a three-dimensional snapshot of the coronary arteries and it enables us to look at any blockages in the heart arteries. CT is best used as a test to exclude coronary artery disease in patients who are at low or maybe intermediate risk of having heart blockages because its best use is to show when those arteries are completely normal.
Melanie: Does somebody, Dr. Kramer, have to be symptomatic to get some of these imaging tests or are any of them sort of a yearly or an every five-year screening process?
Dr. Kramer: We have something called appropriate use criteria in cardiovascular imaging and we assess whether tests are appropriate to use as screening test. Most of the tests I’ve talked about are really reserved for patients who are symptomatic, either having chest pain or shortness of breath or some symptom that points to an abnormality in their cardiac condition. There are a couple of these tests that can be used for screening. I mentioned CT. There is a test called CT coronary calcium scoring, which is a test that doesn’t use dye. It just looks at the heart with a little bit of radiation, but no dye, and looks for calcium in the heart arteries. It turns out that calcium is a marker for the amount of atherosclerotic plaque in the heart arteries. This test is useful for screening in patients who are at intermediate risk of heart disease and asymptomatic. Because if they have a very high calcium score, that points to the need for very aggressive risk factor modification, and if one has a very low or zero calcium, then one can be less aggressive about risk factor modification. Overall, among those tests, in terms of screening asymptomatic patient, calcium scoring is the one that is best used.
Melanie: Speak about your research into improving cardiac imaging and how that’s leading to better diagnosis for patients.
Dr. Kramer: Sure. We’re very fortunate at University of Virginia to have a very strong team in cardiovascular imaging research with individuals in cardiology, radiology and medical imaging, and biomedical engineering, working together to improve cardiac imaging, make it more patient friendly, faster, safer, with improved diagnostic accuracy. One of our major areas of research is in improving cardiovascular MRI, especially stress testing MRI, making it more quantitative, more accurate, and faster and safer. Another area that UVA has worked on over many years is improving nuclear cardiac imaging, in particular, SPECT and PET. That’s an area that we’ve had strong efforts for decades here at the University of Virginia.
Melanie: Tell the listeners why someone should come to UVA for their heart imaging and heart care, and also really your best advice for people who might suspect that they might have heart disease and what they can do about it.
Dr. Kramer: Yeah, as I mentioned, we have a very strong team in cardiology, radiology and medical imaging, not only in making the correct diagnosis using these imaging tests that I’ve described, but taking outstanding care of the patient once heart disease is diagnosed. I think in addition to having excellent care, we also have the latest imaging equipment in all of the imaging modalities that I mentioned: echo, SPECT, PET, MRI, and CT. We have the very latest in technology, and our physicists and engineers are improving the technology on a daily basis to make it even better at making the diagnosis. If a patient has symptoms that they think might be or their primary care doctor thinks it might be a problem with their heart, the best is for their primary care doctor either to refer them to a cardiologist at UVA or may primarily refer them for a test to evaluate their heart, which, if the patient is presenting with chest pain, some sort of stress test either with SPECT or echocardiography or MRI might be indicated. If the patient is short of breath, then perhaps a screening echocardiogram may be the first test that is ordered to look for problems with the heart muscle function or the valves of the heart.
Melanie: Thank you so much. It’s very exciting information. You’re listening to UVA Health Systems Radio. For more information on the UVA Heart and Vascular Center, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening and have a great day.
Advances in Heart Imaging
Melanie Cole (Host): Radiologists and heart specialists are developing new ways to identify heart disease through imaging. My guest today is Dr. Christopher Kramer. He is board certified in internal medicine and cardiovascular diseases at the UVA Health System. Welcome to the show, Dr. Kramer. Speak about, what imaging tests are used to diagnose certain heart conditions and how easy is this process?
Dr. Christopher Kramer (Guest): Thank you for having me, Melanie. There are actually five different tests that we use on a daily basis to evaluate heart conditions, and they all have their individual strengths and applications that we use them for. We can discuss each of them in turn. The most commonly used heart test is echocardiography or ultrasound to image the heart. It is frequently used to assess the function of the heart muscle as well as the function of the heart valves. It is frequently used to screen patients for the first time who may present with shortness of breath and to look for reasons why they may be short of breath, whether there is a problem with the heart function, cardiomyopathy, or problem with a heart valve, either it’s blocked or leaky. That’s the most frequently used reason for echocardiography or ultrasound of the heart. Another commonly used heart imaging test is SPECT, which stands for single-photon emission computed tomography. It is a nuclear technique that involves taking images of the heart and looking at blood flow to the heart muscle. This is very commonly used to again assess blood flow in a stress test. Typically, a patient will walk on a treadmill until they’re exhausted and can get no farther and we will image the patient with SPECT at rest and after stress to look for problems with blood flow to detect blockages in the heart arteries that might lead to reductions in blood flow. That’s a very commonly used cardiac imaging test. A relative of SPECT is a test called PET or positron emission tomography. It is somewhat less used. It is, in a sense, a better version of SPECT, but it is more costly and less available. It is used to again detect abnormalities in blood flow, but is much more quantitative than SPECT. It’s particularly used in certain types of patients, especially those who are on the obese side. Another commonly used cardiac imaging test is MRI of the heart. MRI is a newer test that’s only been available the last 10 or 15 years in heart patients and it is used both for stress testing, but not with an exercise treadmill. For this, we’d use an infusion of a medication that simulates the effect of exercise on the heart and we measure blood flow. In addition, MRI is often used in patients who have reduced heart muscle function or cardiomyopathy, because its best indication is really to understand what has caused the heart muscle to decline in function. That’s a very common use of MRI in 2014. Lastly, a very exciting cardiac imaging test is computed tomography or cardiac computed tomography or CT. CT is an anatomic test. Many of the other tests we’re talking about assess the function of blood flow. CT is really best at imaging the anatomy of the coronary arteries. It gives us a three-dimensional snapshot of the coronary arteries and it enables us to look at any blockages in the heart arteries. CT is best used as a test to exclude coronary artery disease in patients who are at low or maybe intermediate risk of having heart blockages because its best use is to show when those arteries are completely normal.
Melanie: Does somebody, Dr. Kramer, have to be symptomatic to get some of these imaging tests or are any of them sort of a yearly or an every five-year screening process?
Dr. Kramer: We have something called appropriate use criteria in cardiovascular imaging and we assess whether tests are appropriate to use as screening test. Most of the tests I’ve talked about are really reserved for patients who are symptomatic, either having chest pain or shortness of breath or some symptom that points to an abnormality in their cardiac condition. There are a couple of these tests that can be used for screening. I mentioned CT. There is a test called CT coronary calcium scoring, which is a test that doesn’t use dye. It just looks at the heart with a little bit of radiation, but no dye, and looks for calcium in the heart arteries. It turns out that calcium is a marker for the amount of atherosclerotic plaque in the heart arteries. This test is useful for screening in patients who are at intermediate risk of heart disease and asymptomatic. Because if they have a very high calcium score, that points to the need for very aggressive risk factor modification, and if one has a very low or zero calcium, then one can be less aggressive about risk factor modification. Overall, among those tests, in terms of screening asymptomatic patient, calcium scoring is the one that is best used.
Melanie: Speak about your research into improving cardiac imaging and how that’s leading to better diagnosis for patients.
Dr. Kramer: Sure. We’re very fortunate at University of Virginia to have a very strong team in cardiovascular imaging research with individuals in cardiology, radiology and medical imaging, and biomedical engineering, working together to improve cardiac imaging, make it more patient friendly, faster, safer, with improved diagnostic accuracy. One of our major areas of research is in improving cardiovascular MRI, especially stress testing MRI, making it more quantitative, more accurate, and faster and safer. Another area that UVA has worked on over many years is improving nuclear cardiac imaging, in particular, SPECT and PET. That’s an area that we’ve had strong efforts for decades here at the University of Virginia.
Melanie: Tell the listeners why someone should come to UVA for their heart imaging and heart care, and also really your best advice for people who might suspect that they might have heart disease and what they can do about it.
Dr. Kramer: Yeah, as I mentioned, we have a very strong team in cardiology, radiology and medical imaging, not only in making the correct diagnosis using these imaging tests that I’ve described, but taking outstanding care of the patient once heart disease is diagnosed. I think in addition to having excellent care, we also have the latest imaging equipment in all of the imaging modalities that I mentioned: echo, SPECT, PET, MRI, and CT. We have the very latest in technology, and our physicists and engineers are improving the technology on a daily basis to make it even better at making the diagnosis. If a patient has symptoms that they think might be or their primary care doctor thinks it might be a problem with their heart, the best is for their primary care doctor either to refer them to a cardiologist at UVA or may primarily refer them for a test to evaluate their heart, which, if the patient is presenting with chest pain, some sort of stress test either with SPECT or echocardiography or MRI might be indicated. If the patient is short of breath, then perhaps a screening echocardiogram may be the first test that is ordered to look for problems with the heart muscle function or the valves of the heart.
Melanie: Thank you so much. It’s very exciting information. You’re listening to UVA Health Systems Radio. For more information on the UVA Heart and Vascular Center, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening and have a great day.