Despite their known effectiveness and accuracy in identifying heart disease, few cardiologist offices in the U.S. have in-house CT scanners.
The lack of in-office CT scanners often results in patients being referred to hospitals and imaging centers for further diagnostic testing, often resulting delays in care and more expensive treatment for disease that may have progressed even further by the time it’s diagnosed.
Alberto Morales, MD, founder of South Tampa (Fla.) Cardiology, is on a mission to change that. Dr. Morales is an advanced imaging cardiologist, and founded his facility about three years ago with an in-house CT scanner.
At his previous role in a hospital setting, CT scans — which had relatively high levels of radiation and contrast usage — were reserved for symptomatic patients. His new facility now utilizes a SpotLight cardiovascular CT scanner.
“And one of the first things we noticed when we invested in this scanner, and when we started scanning patients, was the mark reduction in radiation, going from 14 to 40 millisieverts of radiation on a typical 64 slice [CT scanner], we were immediately down into the 2- to 3-millisievert dose,” Dr. Morales told Becker’s.
This reduction in radiation was just one of the factors behind Dr. Morales’ vision of expanding the use of this technology in diagnostic cardiology services. He began offering CT scans to 50-year-old patients, particularly those with a family history of heart attacks and whose initial screenings for heart disease, such as stress tests, came back normal.
“My initial suspicion was that these are asymptomatic patients in a pretty wealthy population — they probably don’t have significant heart disease,” he said. “And what I found was astonishing.”
Dr. Morales found that in patients between ages 50 and 60, 80% had heart disease. Among those patients, 30 to 40% had significant, advanced disease, sometimes 70% to 80% blockages — all completely asymptomatic.
He and his team began treating these patients aggressively, Dr. Morales said, and given the high quality of the scans and the reduced dosages of radiation and contrast, decided to re-scan these patients after a round of treatment.
“And oftentimes we saw 80% blockages go down to 50%, 60% blockages go down to 40%,” he said. “We saw a significant pattern, something that no one in the population is doing for these patients.”
He has since continued this diagnostic and treatment process with 40- to 50-year-old patients, and found that up to 70% of that population had heart disease. Among 30- to 40-year-olds, 40% had heart disease, according to Dr. Morales.
This could be an explanation for a phenomenon surrounding heart disease in the U.S., he added. CDC data shows that the prevalence of heart disease among these age groups is much lower than Dr. Morales’ data.
“But then, if you look at overall mortality, the number one cause of death in a 40 to 50-year-old is actually a heart attack,” he said. “How does that make any sense? Now, fast forward, we’ve scanned over 9,000 patients. We’re seeing things that I wasn’t able to see with a 64-slice or with inferior technology, and we’re seeing the significant amount of burden of disease. This explains why we’re seeing what we’re seeing. Heart disease starts very early in your late teens, early 20s, and it starts to progress over decades.”
The technology could be highly promising in a specialty facing a significant shortage of providers amid a growing prevalence of heart disease. According to a survey cited by the American College of Cardiology, wait times for a general cardiovascular visit went up 26% from 2017 to 2022 due to workforce shortages. Patients in the U.S. wait an average of 32.7 days to see a cardiologist, according to a recent report from AMN Healthcare.
Having this technology available in more outpatient settings could chip away at the pressure on health systems by catching disease earlier and addressing it before patients experience major cardiac events, which may require more intensive treatments.
“I think the thing for people is, they go to their doctors, they get their labs checked, they do all the right things. And then, they end up, at age 48, on the table, getting a [catheterization] because obviously this process kind of failed them,” Dr. Morales said. “Now they’re told they have multi-vessel disease and they need open-heart surgery. And so the question is, where could the system have changed to prevent that from happening? The misconception is that they were completely fine a week ago and now they have multi-vessel advanced disease.”
Catching disease early is particularly crucial in cardiology, as heart disease is chronic and typically progresses “silently,” he added. “Far too often, for 50% of people, there were no prior symptoms. The first symptom of a heart attack was the heart attack.”
Dr. Morales added there are numerous other factors at play in the prevalence of heart disease among U.S. adults, with cholesterol levels being a significant one, and that current guidelines for evaluating risk factors for heart disease — particularly those related to measuring cholesterol levels — should be reevaluated, as food processing, dietary and lifestyle habits have changed over time.
“Our guidelines probably need to shift to what is a real [low-density lipoprotein] value, and it’s probably under 70, all across the board,” he said. “I think years of exposure to cholesterol over 70 eventually causes damage to your arteries, and then obviously, sugar, diabetes, smoking, all these other [factors] play a significant role too. But I think it has to start with LDL values and other markers, and what is the real normal baseline.”
Until then, Dr. Morales continues to focus on making this practice more routine and sharing his findings with his colleagues.
“We’re practicing as the way I envision cardiology will practice within the next 10 to 15 years, hopefully sooner than that, which is what we’re pushing,” he said. “I’m doing some research, and obviously, these 10,000 patients that we’ve scanned, we’re collecting data on them, and we’ve opened up a registry to track these patients. We’ll be releasing our data hopefully within the next four to six months.”
