Closer To The Heart

But ignorant sufferers can now take heart. Die-hard believers in technology as the panacea for all human suffering have breached the final frontier to the heart's dark secrets. With cutting-edge imaging tools that can map heart's interiors in minute detail, cardiologists can now calculate the odds a person has of developing coronary heart disease.

Heralding the heart-warming news last week was the Escorts Heart Institute which signed a clinical research agreement with GE Medical Systems, world-leaders in this technology, for setting up a cardiac screening centre at the Institute. Dr Naresh Trehan, executive director of the Institute, is upbeat about bringing this new state-of-the-art diagnostic to India: 'This has major implications for a country like India which spends over Rs 450 crore on cardiac surgeries alone. The new technologies can control the rising incidence of heart diseases, save medical expenses and to a large extent unburden the medical system.'

With over 200 million people at the risk of developing cardiac disease in South Asia, these imaging tools, if successful, could change the way people and doctors deal with the heart. For instance, the traditional diagnostics like eeg, the treadmill test, and angiography become relevant only after 80 per cent of the arterial passage has been clogged. 'These tools only record history. Unlike the new tools, they do not have any predictive power,' explains Trehan. Besides, cardiac screening is much cheaper. 'Compared to Rs 12,000 for an angiography, a cardiac mri and CT would together cost between Rs 5,000 to 6,000,' says he.

Essentially there are two screening tools: cardiac magnetic resonance imaging (mri) and cardiac computed tomography (CT). While mri and CT of the brain have been in use for long and now commonplace in India, it is only in the last one year that these tools have been customised to screen the heart. 'In the past, mri and CT imaging have not proved successful for the heart as it took a long time to acquire the critical images of the beating heart,' explains Jeffrey R. Immelt, ceo of GE Medical Systems. GE was the first company to receive fda approval for its cardiac mri system.

Like the brain mri, the cardiac one creates images of the heart and the blood vessels by bouncing off radio frequency waves in a sea of magnetic field. The images are sharp enough to show any nascent blockages or ruptures in the arteries. But while mri can depict whether blood flow is smooth or not, it cannot show signs of calcium deposits, which is what the cardiac CT does. Presence of calcium in the arteries is now increasingly being linked to thickening of the arteries later. 'Calcium deposits,' explains Trehan, 'mean the patient has 40 per cent higher risk of getting a heart attack in the future. So if one can see these precursors early on, the patient can take adequate precautions to preempt what otherwise would be an eventuality.'

Though eminently useful, these images do not represent conclusive diagnoses. As Trehan says, the absence of calcium deposits or of a broken arterial wall doesn't mean the patient will not develop heart disease. The degree of confidence, agrees Immelt, is about 70 per cent at the moment. 'Part of this joint research is to fine-tune the system so that we can make more reliable predictions,' says Trehan. After US and EU, India is the only country to boast of this technology.

But why India? 'Because,' explains Trehan, 'paradoxically, despite low prevalence of smoking, hypertension, obesity and a largely vegetarian diet, Indians have very high - three times that of Americans - rates of coronary artery disease (cad). That makes India an excellent laboratory to do clinical research on cad.' Besides, whatever the reason genetic, social or psychological thousands of us will get the disease and unless it is intercepted early, many would die for lack of resources for unaffordable surgeries. Cliched it might be, but relevant the slogan still is - prevention is better than cure. If nothing else, a technological decree may force lazy individuals to change their diet and lifestyle patterns for a healthy, hearty future.