New test can warn patients at high risk of heart attack
RELATED
PUNE: Lives of patients at the risk of a heart attack
can now be saved with a non-invasive test that can identify high-risk
unstable blockages that may rupture to cause a heart attack or other
serious coronary event.
Unlike the traditional diagnostic techniques that have so far revolved around finding the tightest narrowing of the arteries supplying blood to the heart, the new test identifies narrowing that does not cause severe blockage, but can rupture and cause a heart attack. The test is a combination of a radioactive tracer and scanning technique, and will take at least five to 10 years to come in the public domain.
British medical journal Lancet published the new study on November 11, 2013 on the use of radioactive tracer 18 f-sodium fluoride (18F-Naf), a known tracer in bone imaging, to accurately identify the blockages that may cause a heart attack.
The research was conducted by a team led by Ahmednagar-born cardiologist Nikhil Joshi at the British Heart Foundation Centre for Cardiovascular Science in Edinburgh, UK, which found that the use of the radioactive tracer with a scanning technique known as positron emission tomography (PET) and computed tomography (CT) could identify the risk of a heart attack and how this would eventually help in initiating early treatment to prevent it.
The test technique is simple: inject the tracer into the patient's veins, followed by a special PET-CT scan, which is commonly used in cancer diagnosis. The fatty plaques in the arteries pumping blood into the heart 'light up' if the plaque (a fatty deposit inside an arterial wall) is at the risk of rupturing. Experts call it detecting the 'ticking time bomb' inside the body.
The new test will mark a paradigm shift in cardiac diagnostics. "Until now, there were no non-invasive imaging techniques available that can identify high-risk and ruptured coronary plaques in patients of heart disease. For the first time, we have shown this is possible and this new technique that can identify high-risk or ruptured coronary plaques, has the potential to transform how we identify, manage and treat patients with stable and unstable heart disease. The next step will be to conduct larger-scale trials of 18F-NaF imaging to assess whether increased coronary 18F-NaF activity is ultimately predictive of future adverse effects," Joshi told TOI in an interview on email.
Elaborating, Joshi said, "The technique is primarily aimed at targeting unstable plaques irrespective of the degree of obstruction. Hence it is possible to diagnose even smaller levels of obstruction, like say 20- 30%, that can rupture if unstable, even in younger patients leading to severe heart attack."
While the technique can be used anywhere in the world, Joshi says it is more relevant in India because of high prevalence of diabetes and coronary disease owing to changing lifestyles.
"However, this is not a screening test for the general population. Its utility is for patients at risk of coronary disease, and patients with angina and previous heart attacks. Moreover, this is an evolving area of research and future studies will determine which patient population will benefit from this type of a scan," Joshi said.
Peer appreciation for the research is pouring in. "It is commendable to have an Indian do such a brilliant research and that too as a principal investigator. The diagnostic method will help identify vulnerable patients," said cardiac surgeon Chandrashekhar Kulkarni of Jehangir Hospital.
Unlike the traditional diagnostic techniques that have so far revolved around finding the tightest narrowing of the arteries supplying blood to the heart, the new test identifies narrowing that does not cause severe blockage, but can rupture and cause a heart attack. The test is a combination of a radioactive tracer and scanning technique, and will take at least five to 10 years to come in the public domain.
British medical journal Lancet published the new study on November 11, 2013 on the use of radioactive tracer 18 f-sodium fluoride (18F-Naf), a known tracer in bone imaging, to accurately identify the blockages that may cause a heart attack.
The research was conducted by a team led by Ahmednagar-born cardiologist Nikhil Joshi at the British Heart Foundation Centre for Cardiovascular Science in Edinburgh, UK, which found that the use of the radioactive tracer with a scanning technique known as positron emission tomography (PET) and computed tomography (CT) could identify the risk of a heart attack and how this would eventually help in initiating early treatment to prevent it.
The test technique is simple: inject the tracer into the patient's veins, followed by a special PET-CT scan, which is commonly used in cancer diagnosis. The fatty plaques in the arteries pumping blood into the heart 'light up' if the plaque (a fatty deposit inside an arterial wall) is at the risk of rupturing. Experts call it detecting the 'ticking time bomb' inside the body.
The new test will mark a paradigm shift in cardiac diagnostics. "Until now, there were no non-invasive imaging techniques available that can identify high-risk and ruptured coronary plaques in patients of heart disease. For the first time, we have shown this is possible and this new technique that can identify high-risk or ruptured coronary plaques, has the potential to transform how we identify, manage and treat patients with stable and unstable heart disease. The next step will be to conduct larger-scale trials of 18F-NaF imaging to assess whether increased coronary 18F-NaF activity is ultimately predictive of future adverse effects," Joshi told TOI in an interview on email.
Elaborating, Joshi said, "The technique is primarily aimed at targeting unstable plaques irrespective of the degree of obstruction. Hence it is possible to diagnose even smaller levels of obstruction, like say 20- 30%, that can rupture if unstable, even in younger patients leading to severe heart attack."
While the technique can be used anywhere in the world, Joshi says it is more relevant in India because of high prevalence of diabetes and coronary disease owing to changing lifestyles.
"However, this is not a screening test for the general population. Its utility is for patients at risk of coronary disease, and patients with angina and previous heart attacks. Moreover, this is an evolving area of research and future studies will determine which patient population will benefit from this type of a scan," Joshi said.
Peer appreciation for the research is pouring in. "It is commendable to have an Indian do such a brilliant research and that too as a principal investigator. The diagnostic method will help identify vulnerable patients," said cardiac surgeon Chandrashekhar Kulkarni of Jehangir Hospital.
