Research released this week at the annual conference of the American Society of Echocardiography (ASE; Raleigh, North Carolina) reports that stress echocardiography, a heart ultrasound performed during stress testing, is a more accurate method for identifying women at highest risk for coronary artery disease (CAD) than traditional stress testing and clinical risk factors.
CAD is the No. 1 killer of women, and studies indicate that a woman is 30 times more likely to die of CAD than breast cancer.
Unfortunately, women, unlike men, often do not show the classic symptoms of heart attack, such as sweating, chest pain or shooting arm pain, therefore it is more difficult to identify when they have blockages in arteries.
"Our study shows that stress echocardiography can stratify women at the highest risk of coronary artery disease into those that are at risk of having a heart attack or cardiac death. This allows women to receive more focused and appropriate treatment that is customized to their specific risk level and outcomes," said Farooq Chaudhry, MD, director of echocardiography, associate chief of cardiology, St. Lukes-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons (New York).
The research, conducted at the University of Nebraska Medical Center (Omaha) found that real-time perfusion echocardiography, a heart ultrasound technique that allows doctors to view the blood flow in the heart muscle, helped identify diabetics without symptoms who are at risk for coronary artery disease.
Traditional heart ultrasound continues to remain the best test for identifying many different abnormalities in the heart.
However, being able to assess the blood flow within the heart muscle by using a contrast agent, in addition to defining abnormalities, would be a major breakthrough for diagnosis and treatment of heart diseases.
By looking at the structural abnormalities, pumping function of the heart and the blood flow within the heart muscle, a stress test using heart ultrasound with a contrast agent may allow doctors to diagnose and treat more diabetics with previously unknown blockages of the heart arteries.
In other research from the conference:
Contrast echocardiography, a heart ultrasound study performed with a small intravenous injection of an ultrasound contrast agent, can be used to separate patients presenting with low-risk and non-life threatening chest pain from those who may be experiencing a heart attack.
This research shows that myocardial contrast echocardiography (MCE) may more accurately diagnose life threatening heart disease so as to decrease unnecessary hospital admissions and reduce patient cost.
The ultrasound contrast agents used in the study are currently being used to improve ultrasound image quality, according to the study, and FDA approval is pending for the use of these contrast agents to evaluate blood flow in the heart muscle.
Doctors evaluated 957 patients complaining of suspected heart chest pain by performing the MCE study. MCE allowed researchers to view the heart borders and evaluate the blood flow throughout the heart muscle. More importantly, MCE allowed doctors to identify abnormal blood flow, which can be a sign of severe blockages in the coronary arteries.
Results showed that by using MCE to evaluate patients presenting with suspected heart chest pain, 55% of the patients studied could have been discharged from the emergency department, avoiding admittance charges and costly follow-up testing. The patients who had the MCE study saved roughly $700, plus the inconvenience of hospital stays.
Research released, also on Friday, found that screening vascular ultrasound (SVU) is effective in identifying patients with cardiovascular disease — the nation's number one killer — before they show symptoms and become ill.
Dr. John Postley of Columbia University (New York) evaluated 398 patients, ages 33-79, using both Framingham Risk Score (FRS) and SVU. Of the 398 patients, SVU found 171 patients to have plaque build-up in the arteries of the neck and thigh. Of those 171 who were found to actually have plaque build-up, 25% of men and 35% of women were categorized as low risk by FRS.
SVU identified cardiovascular disease in these patients that FRS alone might have otherwise overlooked. The findings also confirm the importance of assessing plaque levels in both the thigh and neck veins since 20% of the 171 patients with plaque would have been missed if only plaque levels in the neck had been assessed.
"These findings suggest that even patients with low Framingham Risk Scores may have cardiovascular disease, as demonstrated by the presence of plaque build-up, and that SVU is an effective method to identify these patients," said Postley. "This combination of technologies is wonderful news for the medical community as it will help identify people with clogged arteries before they even begin showing symptoms, allowing physicians to be more proactive in treatment."
An association between obesity and left ventricular hypertrophy (LVH), a condition that can potentially cause heart failure and rhythm problems, was found as a result of research released Friday. That finding may improve the understanding of the effect of obesity on the heart.
"These results are another stake in the ground that supports healthy lifestyles for the benefit of heart protection," said Dr. Movahed of the University of Arizona Server Heart Center (Tucson). "This gives us further evidence that maintaining a proportionate BMI [body mass index] could be beneficial for protection of heart function."
Using a database of 17,261 heart ultrasounds, doctors evaluated the occurrence of LVH in relation to gender, valvular abnormalities, age, BMI and body surface area. The heart ultrasounds allowed researchers to view a moving image of the heart to evaluate structure and function.
Results showed that narrowing of the aortic valve was the strongest predictor of LVH, followed by gender and BMI. Men have thicker hearts than women in general; however, obesity raises risk levels for the development of LVH in both genders even further as it causes the heart to work harder to pump blood.