Coronary CT angiography

And so before I click the record button, I was asking for like a little bit of clarity in language.

I was like, should I call it coronary CT or cardiac CT? You started to answer and I cut you off, but I would love to take that question again now that we're live.

Honestly, for the purposes of the debate, so to speak, in terms of non-gated versus or retrospective, that would be a coronary.

But I think it's more broadly we can just talk about cardiac CT. That's fine.

Coronary CT is a subset of cardiac CT.

And like coronary CT has been around for a while, but it seems like more recently it's really taken off in a big way.

Yes.

So there's a few reasons for that.

In those cases, your doctor may recommend a CT coronary angiogram.

It's called the CCTA.

which uses contrast dye to show both calcified and soft plaque and how narrow your arteries are.

And a calcium score is usually recommended for people between age 40 to 75 at intermediate risk, but talk with your doctor about whether it's right for you.

If I wanted to make sure and ensure that nothing's clogged, there's no plaque developing, like what are some tests that you would recommend me to go to?

So you could take a test called a CCTA with a AI analysis of clearly where you can actually assess for soft and hard plaque in your coronary arteries.

Many people don't realize this, but there's actually a more non-invasive, not that this is invasive, but there's more of a non-invasive test where you can do a ultrasound, a duplex ultrasound of your lower extremities where we can look at plaque development in your femoral arteries.

So the arteries leading to blood flow in your lower extremities, and that usually is what shows up first.

And we know that it's around y- all your organs.

In fact, there's some really great tests that are starting to come out now that are measuring off of CCTA.

They're measuring the amount of visceral fat that you have around your heart.

And these things, you know, they, they wreak havoc on your body long, long term.

Advanced imaging has become a key part of the diagnostic criteria, particularly for prosthetic valve and device infection, where echo is often inconclusive.

Cardiac CT angiography is excellent for detecting perivalvular abscesses and pseudoaneurysms, especially around prosthetic aortic valves, and it also allows assessment of the coronary arteries before surgery, avoiding invasive angiography with the risk of dislodging an aortic vegetation.

FDG PET/CT detects active inflammation around a prosthetic valve, along device leads, and in distant sites such as the spleen, spine, or other organs, which can reveal emboli or the source of infection.

However, it is less useful for native valves and within the first three months after valve surgery.

For decades, we have used the Duke criteria, which combine microbiology, imaging, and clinical findings.

In twenty twenty-three, two updates appeared, the European Society of Cardiology guidelines and the Duke/ISCVID criteria from the International Society for Cardiovascular Infectious Diseases.

Both broaden the criteria by including modern imaging, such as cardiac CT and FDG PET, and modern microbiology, such as molecular tests.

The major criteria are, first, microbiological evidence, atypical organisms in multiple blood cultures or positive tests for Cox, E. L and other difficult organisms, and second, imaging evidence of endocardial involvement, a vegetation, abscess, pseudoaneurysm, fistula, new valve perforation, or new dehiscence of a prosthetic valve.

Um, and that's a big deal.

That is one more thing I brought up in the paper, CAC versus CCTA.

Oh, yeah.

Very briefly, just, you know, for asymptomatic people, or patients I should say, who want to get these scans done, you know, coronary ar- ars- artery calcium, you can get done pretty easily.

It's typically ran if somebody's asymptomatic, versus if somebody's symptomatic, they should consider getting a CCTA, you know, contrast dyes, even at least once every couple years if they're having symptoms, right? So it's a tough position to be in, but, you know, technology's come a long way for radiation exposure, like you said.

It's, it's so my opinion.

I've never been more bullish on CAC than I've been...

Yeah.

CCTA.

Yeah.

Yeah.

I see a lot of, a lot of buzz about CCTA.

People want to get that.

So I went and got one done.