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Heart stress tests much less effective than CT to detect clogged arteries

by Lee Nelson, Contributing Reporter | October 27, 2015
Cardiology CT Risk Management X-Ray
When a patient presents at a hospital with shortness of breath, chest pain and/or extreme fatigue, they will most likely undergo a stress test. But researchers at Johns Hopkins University in Baltimore have discovered that a CT scan could be a better way of detecting any blockage in a person's arteries.

“My hope is that the field of cardiology will change its approach to patients with suspected coronary heart disease – patients with chest pain,” said Dr. Armin Zadeh, lead investigator for the research and associate professor of medicine at Johns Hopkins, told HCB News.

“I believe our traditional sequence of testing (stress testing first) should be reversed for most patients. Unless the probability of coronary heart disease is low, the patient should get a CT first because of some degree of blockages, and then undergo either stress testing or cardiac catheterization,” he added.

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The study showed each patient undergoing three types of tests for clogged arteries which included non-invasive CT angiograms, traditional catheter-based coronary angiographies and then an exercise stress test two months later. The scans correctly discovered blockages in nine out of 10 patients, while stress tests only found six out of 10.

The report was published online in the journal Circulation: Cardiovascular Imaging.

CT angiogram has just recently become another non-invasive test for heart patients. A handful of studies, Zadeh said, have suggested that these could be superior to any other tests. But uncertainty remains because of the small number of people actually involved in the research.

The newer CT scans give out much lower doses of radiation than the scans used in nuclear stress tests, but it all varies from hospital to hospital, Zadeh’s report said.

“Since the costs are similar (for CT scans and stress tests), physicians will not be deterred by costs to order a CT. The key issue is reimbursement by insurance carriers,” he said. “If doctors have to ask for authorization prior to ordering it, they will be less inclined to order a CT study -- which is the actual deterrent.”

Patients may simply inquire about a CT as an alternative to stress testing. Unfortunately, insurance companies may decline payments for a CT depending on the patient’s coverage.

Currently guidelines from the American Heart Association and the American College of Cardiology call for a stress tests in all patients who show signs of heart disease. Only patients with bad or borderline stress test results undergo CT angiograms.

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