Ask the doctors: No single test will assure heart health
Q: I had a carotid ultrasound that shows 0% stenosis on both the right and left sides. Does that mean no plaque was seen? Also, is there any gold-standard test for heart health, such as the carotid ultrasound I had?
A: At this time, there is no single test or tool that can assess heart health. This is because the cardiovascular system is complex and many factors can affect it. We're talking not only about the heart muscle itself, but also the blood vessels that serve it.
Other variables include blood pressure, age, weight, body fat percentage and blood lipid levels. The presence of visceral fat, metabolic health, lifestyle, stress and genetic risk also play important roles.
That said, a combination of scans and tests can be used to create a comprehensive profile of cardiovascular risk. This refers to the probability someone will have an event that damages the heart muscle, which we call a heart attack.
If poor blood flow is detected, then treatment options might include angioplasty, stent or bypass surgery. Unstable angina is the condition of reduced blood flow to the heart with physical symptoms, including sudden chest pain and dizziness, but that hasn't caused a heart attack yet.
The carotid ultrasound you had measures the thickness of the walls of the blood vessels in the neck that supply blood to the brain. The images also show whether plaque is present and how much there is. Greater amounts of plaque correlate to more severe risk of disease.
Your 0% reading means there is no measurable narrowing of the vessels. It is still possible there may be some plaque, but not enough to narrow the artery.
The result of your carotid ultrasound is quite reassuring. However, it is important to understand that it cannot capture all aspects of cardiovascular risk. Other tests to assess the arteries of the heart, as well as heart function at rest and under stress, are needed.
Tests that evaluate heart function include an echocardiogram. It uses sound waves to provide moving, real-time images of the heart. A stress echocardiogram takes images of the heart before and after exercise. Nuclear medicine scans can also be useful. These use radioactive isotopes to see the flow of blood through the heart. They can identify areas of reduced blood flow, particularly during stress.
Many more cardiologists are now ordering coronary artery calcium scans, also referred to as CAC tests. This test uses X-rays to look for the presence of calcified plaque in the coronary arteries. Also useful is the computed tomography angiogram, or CTA. It uses X-rays, contrast dye and computer processing to create detailed images of the blood vessels in the heart.
Not everyone needs each of these tests to assess heart health. Decisions about their use should be made based on your own medical history and general health. These decisions should always be made in consultation with your doctors.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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