Heart diseases have long been the leading cause of death in the United States. Now better imaging technologies are giving doctors a clearer picture of the heart. The result: more accurate and cheaper diagnoses, and less "false positives" that result in risky surgery.

Two of these new technologies, a high-resolution CT scanner and digital echocardiography, have recently become available in San Diego County. They use different scanning technologies, X-rays and ultrasound respectively, and have different strengths and weaknesses. Both are speedy, performed in just minutes, painless and noninvasive. These aren't the only imaging technologies, but they are the most commonly used.

These technologies are decades old. But their resolution has been improved, capturing smaller details. Because the heart is in constant motion, that has been an extraordinarily difficult challenge to meet.

In the last few decades, great progress has been made in treating heart disease and reducing the death rate. From 1993 to 2003, the death rate from coronary heart disease declined 30 percent, according to the American Heart Association. But it remains the No. 1 killer, the cause of 479,305 fatalities annually in the United States, according to the association.

Accuracy and safety

There's plenty that can be done for those with heart disease, including numerous forms of medication and surgery. But accurate diagnosis is key. And for all tested, safety is a concern. Invasive procedures have the highest risk, but tend to be most accurate. One example is cardiac catheterization, in which a catheter is inserted into a blood vessel and a contrast agent released in the coronary vessels.

Cardiac catheterization is accurate, but carries a 3 percent risk of complications and a 0.1 percent risk of death, said Dr. Jon Robins, medical director of the outpatient Heart Imaging Center in La Jolla. This year the center installed the new 64-CT scanner, which uses 64 detectors to get focused images of X-ray beams in "slices" of the heart. Another 64-CT scanner is in use at Regents Imaging in Oceanside, the only center in North County with the equipment.

The 64-CT test doesn't carry the risk of catheterization, and can detect heart disease without the need for the invasive procedure, Robins said. It takes the images in seconds. The same Toshiba-made equipment was installed last year at Johns Hopkins Medicine in Baltimore, one of only two of its kind in the United States at the time.

And there's the power of a picture. Showing patients graphically what their heart disease looks like hits home with them, Robins said. They take doctors' advice more seriously.

"When you show patients their heart, they get honest," Robins said. "It has the ability to change people's behaviors."

Robins said improved cardiac diagnosis will especially help women. He said the focus on diseases that affect primarily women, such as breast cancer, tend to overshadow the risk to women from heart disease, the leading killer of women as well as men.

"More women die of heart disease every year than the next 14 causes of women's death combined," Robins said.

The American Heart Association warned last year that women are not tested enough with cardiac imaging technologies.

Into the computer age

Earlier this year, Palomar Pomerado Health bought four Philips iE33 digital echocardiography devices, which use finely focused beams of ultrasound. They are now in use at Palomar Medical Center in Escondido and Pomerado Hospital in Poway. Escondido residents Ben and Darlene Fauber helped pay for the devices.

"It's painless and 100 percent noninvasive," said Dr. Robert Stein, medical director of cardiovascuscular services at Palomar Pomerado Health.

The devices produce 3-D images of the beating heart, 2-D images and specific measurements of cardiac function.

"It can look at left ventricular size and function, it can look at valvular function," Stein said. "One of the neatest things it includes is a Doppler program which allows us to measure (blood) flow velocity and direction."

Two-dimensional images can be stored and e-mailed in the common JPG or TIFF formats, Stein said.

Included with the system is digital recording and reading technology that Stein says will soon do away with videotape now used to record images. Instead of rooms full of tape and film, images will be stored in computer files that can easily be viewed and transmitted across computer networks. For example, a cardiologist at Pomerado Hospital will be able to call up a file at Palomar Medical Center.

Taking readings with the devices is a 20- to 30-minute process, Stein said. An ultrasound source that also picks up the reflected sounds is placed over the chest and moved around to get the images.

Different strengths

Neither the 64-CT scanner nor the digital echocardiography technology is better for all purposes.

"They just do different things," Stein said.

The 64-CT devices are good at detecting calcium deposits in the coronary arteries, a test called cardiac calcium scoring. The more calcium deposits found, the greater the level of heart disease. The calcium scoring test is recommended for men over 45 years old and women over 55.

Robins said a heart exam with the 64-CT is 98 percent accurate in determining if a patient has normal heart function or minimal disease. There's then no need for more invasive tests. By contrast, other tests such as stress echo or electrocardiograms (EKGs) or nuclear scans give a 30 percent false-positive rate.

Economics comes into play here, Robins said. In addition to being more accurate, the 64-CT test costs about $1,000, compared to six times that much for a cardiac catheterization exam. Last month, Medicare approved coverage for the exam. Medical approval of a new test is often followed by approval by private insurers.

There's an added benefit from CT heart scans: they detect other diseases, too.

Signs of lung cancer, and potentially dangerous blood clots and aneurysms were detected in patients undergoing a CT scan to find heart problems, according to a 2005 report by cardiac imaging specialists from the University of Michigan Health System.

Out of 98 patients given a CT heart scan, 43 showed signs of other diseases, the specialists said on May 16, 2005, at the American Roentgen Ray Society's annual meeting in New Orleans.

The specialists said the findings show that it's important that specialists in radiology, in addition to cardiologists, examine CT heart scans.

Contact staff writer Bradley J. Fikes at (760) 739-6641 or bfikes@nctimes.com.

Below are some local clinics providing new cardiac imaging services:

64-CT scans:

Regents Imaging

3909 Waring Road, Suite C

Oceanside, CA 92056

(760) 630-0014

www.northcountyrad.com/regents-imaging-oceanside-california.htm

Imaging Healthcare Specialists

4150 Regents Park Row, Suite 195

La Jolla, CA 92037

(858) 622-6464

www.imaginghealthcare.com

Digital Echocardiography:

Palomar Pomerado Health

Escondido and Poway

(800) 628-2880

www.pph.org/dept_and_services.aspx?nd=792