Surprising results from a heart scan13 years, 7 months ago
Posted on Jul 27, 2005, 7 a.m.
By Bill Freeman
I have had cholesterol scores of more than 300 for decades, and several doctors have urged me to take statin drugs, but I had a bad experience with Lipitor, the only one I tried. Recently, my total cholesterol jumped to 380, and I told my doctor I would try another, but only if he could show me evidence that my arteries were actually clogging.
Recently, my total cholesterol jumped to 380, and I told my doctor I would try another, but only if he could show me evidence that my arteries were actually clogging.
He called a friend, a radiologist experimenting with a new technique, a substitute for coronary angiograms, which can cost $4,000 or so and require a day in the hospital.
The radiologist, Dr. Burton Cohen, slowed my heart with a beta blocker, injected dye into my veins and put me through his fastest CT scanner in less than 20 minutes, taking pictures of "slices" of my heart.
I was afraid that I would discover that I had serious narrowing, or at least a high calcium score - a measure of the calcium bonded to cholesterol in plaque. Scores in excess of 400 predict imminent heart trouble.
Instead, to my astonishment, my score was 11, just one point above the negligible risk category. The computer found just two pinhead-size bits of calcium.
The scan itself was just plain fun. The screen showed what amounted to a black-and-white television picture of my torso, as seen from my feet, the way it would look if it were fed through a salami slicer. The white rectangle at the top of the screen was my breastbone. The oxtail-shaped thing at the bottom was a vertebra. The bottom tip of my heart was in the middle. Following Cohen's finger, as each slice lifted away, I could see the heart widen. The coronary arteries that fed it - about one-fifth of an inch, or half a centimeter, in diameter- appeared on its edges.
"They're just white circles," I said.
"Circles is just what you want," he said. "If they have irregularities or they're cut off, that's bad. This looks real nice."
After Cohen had followed each circle up to the aorta, he tapped some keys, and the computer reassembled the slices into the "angiogram" view - a transparent gray heart (No.2). My arteries were a whitish web curling around it like spaghetti, and I could see the two calcium specks - brighter, but small and unthreatening.
He tapped some more keys.
"This untangles the spaghetti," Cohen said (No.3). "It's called the 'rotisserie view.' It straightens out each artery like a barbecue spit."
There they were, a set of clean white pipes.
"Obviously," the radiologist said, "I have a vested interest in this. But I think this technique may turn out to be better than angiography.
"That only shows you the lumen, the straw you put the dye through. With this, you can see the walls, too, which is where the soft plaque sticks."
For comparison, he dialed up another patient's scan (No.4). The clots of calcium in the tubes looked like a ghostly pileup. "Those are really ratty vessels," he said.
The man's score was 1,360. He had high cholesterol and chest pain but had resisted angioplasty. After the scan, he had angioplasty and a stent.
I thanked the doctor and walked back to work through Central Park, just floating over the paths. Twenty years of feeling guilty, of thinking that every time I ate a scoop of ice cream I might be cheating my children out of growing up with a father, had suddenly been lifted.
My own doctor seemed pleased, in a rueful way.
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