MUSC plays key role in study of what radiologist calls better, less costly way to analyze coronary artery disease

A noninvasive way of testing for and analyzing coronary heart disease — a method already in use at MUSC Health because it showed such early promise — proved better than traditional testing in a large, international clinical trial that the Medical University of South Carolina was part of.

Joseph Schoepf, M.D., director of Cardiovascular Imaging at MUSC Health, led MUSC’s part of the PRECISE trial, enrolling more patients than most other study sites in the U.S. PRECISE stands for Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization.

“This process has just drastically changed the management of patients who are suspected of having coronary artery disease. It makes it much more specific. FFRCT technology is a very elegant and non-invasive method,” Schoepf said, referring to fractional flow reserve – computed tomography.

Normally, fractional flow reserve involves inserting a tube called a catheter to measure blood pressure and flow through a coronary artery. But Schoepf said the new process called Precision Pathway, developed by the company HeartFlow, starts with a standard heart scan. The radiologist then uploads the CT images so that artificial intelligence can build a model of the patient’s arteries, showing what is or is not going wrong without going under the skin.

“We can tell without subjecting that patient to any invasive tests whether this patient will benefit from an interventional procedure or not. And that is obviously good for the patient because it helps many of them avoid invasive procedures,” Schoepf said.

“There was some doubt lingering whether this technology is truly superior to the traditional way, like nuclear medicine testing, treadmills, things like that. Until now, we lacked definitive proof that this technology does what we always believed it does, giving us the ability to safely differentiate patients who should undergo invasive treatment and those who should not.”

The trial, which involved more than 2,000 patients with suspected coronary artery disease, found the new system improved non-invasive diagnostic accuracy, reduced unnecessary tests and was 75% more likely to identify patients who needed treatment than traditional tests were.

The system offers a new solution to an old problem that plagues millions of Americans. Coronary artery disease, the most common type of heart disease, is caused by the buildup of cholesterol and other substances in the wall of the arteries that carry blood to the heart. That makes it harder for the blood to get through and over time can lead to heart failure if untreated.

Symptoms of coronary artery disease include:

• Chest pain.
• Weakness.
• Lightheadedness.
• Nausea.
• A cold sweat.
• Pain/discomfort in the arms or shoulder.
• Shortness of breath.

-Source: CDC

Schoepf said if someone feels those symptoms and suspects heart trouble, they should contact MUSC Health’s Heart and Vascular Center or another hospital with expertise in this area. MUSC Health was recently ranked among high performing hospitals by U.S. News & World Report for its track record in treating heart failure.

Schoepf, a professor with appointments in radiology, cardiovascular medicine and pediatrics at MUSC, also serves as Vice Chair of Research at the Department of Radiology and Radiological Science. He said MUSC Health strives to stay on the cutting edge of cardiac imaging technology such as the HeartFlow system.

“We have so many firsts. We were the first institution in the United States to receive advanced dual source CT technology. Just in July of last year, we were the first — with the Mayo Clinic in Rochester — to take delivery of one of the first photo counting CT scanners in the nation. So what I wanted to make sure is that with these non-invasive techniques, MUSC remained at the forefront of cardiac care and that we can deliver best possible technical innovation to our patients.”