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Would 3D CT Scan Outweigh Stress Test?
 

When one is suspected of having a heart disease, he or she will certainly go to see a doctor. Before taking any test, the doctor will first perform a physical examination and ask about the personal and family history. Based on the patient’s conditions, the doctor might ask the patient to take not only blood test but also others including traditional stress test or modern CT (computerized tomography) scan.

A stress test, sometimes also called a treadmill test or exercise test, helps the doctor find out how well the heart handles its workload. It usually involves walking on a treadmill or riding a stationary bike while the heart rhythm, blood pressure and breathing are monitored. A CT scan, on the other hand, combines a series of X-ray images taken from different angles and uses computer processing to create cross-sectional images, or slices, of the bones, blood vessels and soft tissues inside the body. The images scanned provide more detailed information than the normal X-rays do.

Now the question is: which one of these is best for diagnosing heart disease? Many doctors have been guessing the answer for years. Perhaps the new study could end the guessing. Researchers from Duke University reported that the rates of eventually having serious heart events were the same whether stress test or CT scan were used to diagnose the heart disease patients.

Presented at the American College of Cardiology's 64th Annual Scientific Session held between March 14 and 16, 2015 in San Diego, the results of the federally funded trial were also published on March 14, 2015 in the ‘New England Journal of Medicine’.

10,003 patients were involved in the trial. They visited 193 health centers in the United States and Canada, and had no prior diagnosis of coronary artery disease. They had, however, suspected symptoms of heart disease, and nearly all of them had at least a risk factor like high blood pressure, diabetes or a history of smoking. Half of the participants were randomly selected to undergo a CTA (computed tomographic angiography), and the rest were asked to take stress tests, either an exercise electrocardiogram, a stress echocardiography or a nuclear stress test, which uses radioactive dye.

Surprisingly, the rate of bad outcomes among the heart patients studied was found to be extremely low. In both test groups, only about 3 percent of the participants had heart attacks, suffered major complications, needed hospitalization for chest pain or died during 2 years of tracking. Compared to stress test, CT scans were found to be more accurate in identifying patients who need follow-up testing and/or artery-opening medical procedures, and also more accurate in excluding patients who do not need.

In the trial, potential drawbacks of both types of tests were not discussed. But according to researchers, CT might be the safer test because a CT scan involves much less radiation than the most popular functional test like a nuclear stress test, which involved injecting radioactive dye to make blood vessels show up on X-ray images. Patients are still subject to some risks of getting cancer, as cautioned by other health professionals not involved in the study.

Cost comparison was not clearly made in the findings, too. A 2011 observational comparison of these two tests among Medicare patients, published in the ‘Journal of the American Medical Association’, found that health-care spending was substantially higher among patients who received a coronary CTA compared with traditional stress test.

Anyway, the new findings should prompt doctors to consider other approaches like watchful waiting instead of stress tests or expensive scans. After all, the incidence of heart attacks or heart complications was only 3 percent.

Each year, about 4 million Americans report heart symptoms like chest pain or shortness of breath. Perhaps, people should strive to stay healthy instead of seeking medical helps later. Heart disease prevention tactics that seem to be working include lowering cholesterol through diet and medicine, keeping blood pressure in check, quitting smoking, and engaging regular physical activity.

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