Can virtual angiography be performed on every patient?

With advancements in medical technology reflecting in imaging methods, early diagnosis of cardiovascular diseases is now possible. However, there are many misconceptions about "Virtual Angiography" (Computed Tomographic Angiography), which has been frequently discussed in recent years. Anadolu Health Center Cardiologist Dr. Gürsel Ateş explains virtual angiography...

What is virtual angiography?

Virtual angiography involves administering a certain amount of contrast material through the arm's vein while simultaneously obtaining thin cross-sectional images of the heart through computed tomography (CT), which are then observed digitally to visualize and evaluate the coronary arteries.

How is virtual angiography performed?

The procedure is done in a manner similar to applying an intravenous drip; the vein in the arm is accessed. Virtual coronary angiography is performed in two stages. In the first stage, to show calcification in the heart vessels, an initial scan is performed without the use of contrast material. The images obtained are mathematically evaluated to assess possible calcifications in the vessels.

What is the difference between virtual angiography and traditional angiography?

If the calcification in the patient's heart vessels is below certain levels, the contrast material is then administered through the vein. This is the key difference from traditional angiography. Cross-sectional images are obtained using a computer. These images are then displayed in three-dimensional form on the computer. The key aspect of this process is capturing images of the blood as it passes through the coronary vessels. To create a full image of the heart, the images recorded during a few heartbeats must be combined using computer technology.

How long does virtual angiography take to complete?

The actual procedure for virtual angiography is very brief. The images are completed in as little as 6-24 seconds. The most important factor in the procedure is the preparation of the patient. The heart rate must be around 60 beats per minute for the procedure to be performed. If the patient's heart rate is at this level, the scan can be completed immediately. For patients with a heart rate above 60 beats per minute, heart-rate-lowering medications are administered orally or intravenously to bring the heart rate to the desired level before completing the procedure. In some patients, this may take longer to achieve.

What are the side effects of virtual angiography? Is it harmful?

The most significant benefit of virtual angiography is that it eliminates the need for traditional angiography. During the virtual angiography, the patient receives a certain amount of radiation, and the contrast material used during the procedure may put a load on the kidneys. For this reason, virtual angiography is not a procedure that can be repeated frequently. It must be performed on suitable patients and at the right time.

Who can undergo virtual angiography?

If a patient's stress test is problematic, they are under the age of 40-50, and they have symptoms such as chest pain, virtual angiography may be appropriate. There is a group of patients whose stress test results are neither clearly positive nor negative, and further investigation is required to determine if there is a problem with the vessels. Virtual angiography is not recommended for individuals with normal stress test results. There are two suspicious groups: patients with issues indicated by the stress test results, and those with no issues identified by the stress test. In this group, performing virtual angiography on a patient with a high likelihood of having a problem could lead to issues. If the likelihood of disease is high, the need for a coronary angiography after virtual angiography is also high, which may result in unnecessary procedures.

Who is likely to have problematic results in virtual angiography?

People with high cardiac risk factors, such as long-term diabetes, hypertension, and high cholesterol levels, as well as those over 50 years old, are more likely to have problematic results. Individuals who have previously been diagnosed with coronary artery disease have an even higher likelihood of having problematic results in virtual angiography.

Can virtual angiography be performed regularly (routinely)?

There are incorrect reports suggesting that virtual angiography is necessary for everyone who exercises or that businesspeople routinely undergo virtual angiographies.

Virtual angiography is not a method used to assess heart risk. From a businessperson's perspective, if the stress test is normal and they have no complaints like chest pain, there is no need for virtual angiography. The method is used to determine whether coronary artery disease exists or if existing coronary artery disease requires intervention, not for risk assessment.

If a patient's stress test results are poor but the likelihood of disease is low, virtual angiography can be performed. However, if the stress test is negative and the patient has no significant symptoms, virtual angiography is unnecessary. Ultimately, this method also carries certain risks. While some businesspeople may wish to have virtual angiography annually, this is not advisable.

Who should not undergo virtual angiography?

• Individuals with kidney dysfunction,
• Those with hyperthyroidism,
• People with heart arrhythmias,
  are not suitable candidates for virtual angiography.

Is virtual angiography a commonly used method?

Virtual angiography is a frequently used diagnostic method at Anadolu Health Center for suitable patient groups. This examination is used not only for coronary angiography but also to evaluate all vascular structures in the body.

What are the areas where virtual angiography gives the best results?

The areas where virtual angiography gives the best results are structural heart and vascular disorders. It also provides near-perfect results in evaluating grafts added to patients who have undergone bypass surgery. Excluding coronary artery disease is one of the most successful areas of this test, but sometimes it may overestimate coronary artery stenosis.

How much time should pass between two virtual angiographies?

It is not appropriate to give a specific time frame; however, there must be a significant reason for repeating the virtual angiography. This test is not suitable for use as part of a routine check-up

Can virtual angiography be applied to children?

It is generally used in children with structural heart defects and vascular abnormalities. Sometimes, it can yield better results than conventional angiography.

What are the common misconceptions about virtual angiography?

Virtual angiography is not a screening test. The most appropriate use for this test is to show that coronary artery disease is not present in patients with a low risk of the disease.

Can you provide information about the accuracy of the results?

The strongest area of virtual angiography is showing the absence of coronary artery disease. When the disease is present, it can correctly identify the condition with an accuracy rate of 80-90%. In structural heart and vascular diseases, and in evaluating the patency of grafts added after bypass surgery, the accuracy rates have been found to be nearly 100%.