Breakthroughs in Cardiac CT Triage at Cardiovascular Specialists of Southwest Louisiana

The doctors at Cardiovascular Specialists of Southwest Louisiana have performed almost every treatment or procedure in cardiology available anywhere in the world—except for heart transplantation—right here in Lake Charles, Louisiana. Being a part of many medical firsts in our region—heart catheterizations, dual-chamber pacemakers, and implantable defibrillators—Michael C. Turner, M.D. is no stranger to breaking new ground for cardiac patients in Southwest Louisiana. Providing world-class care to cardiovascular patients has kept Dr. Turner on the leading edge of his field. That edge moved to exciting new territory at the turn of the century. “In 2002, I saw the first images being generated by cardiac CT angiography, and I fell in love with it,” said Dr. Turner. “I knew at that time cardiac CT scanning would change our level of care and it has been my primary focus for that past 15 years.”
In 2006, Dr. Turner was the first cardiologist to perform cardiac CT angiography in Lake Charles. Two-and-half years ago, he and the cardiologists at Cardiovascular Specialists of Southwest Louisiana broke new ground by implementing the cardiac CT scanning method in the emergency room, putting this revolutionary technology to work on the frontend of a heart patient’s journey. The term is cardiac CT triage, and it is changing the process of determining a heart patient’s immediate needs, and the amount of time they spend in the hospital.
"The standard of care at this time is to admit to the hospital most of those patients coming into the emergency room with chest pains,” said Dr. Turner. "The patient then ends up staying in the hospital overnight. They typically have some test the following day; usually a stress test, or a nuclear stress test. If that’s not normal, then they might stay another day and have a coronary angiogram, which is an invasive test. More than half of those patients will have no heart disease.”
Dr. Turner further explained,"When a person comes into an emergency department with chest pain, the top thing on the emergency room doctor's mind is whether this chest pain is related to coronary artery disease. If it’s not then the risk of a heart attack is very low, and a primary care physician could typically treat that patient, and they can often be discharged from the emergency room.”
"We have instituted the cardiac CT triage program in the emergency room to quickly determine a patient’s immediate risk heart attack or chest pain event in the future,” said Turner. “You do not want to send a patient away that is at risk of heart attack or chest pain. With the non-invasive cardiac CT triage scan, in about 10 seconds, we get detailed images of the heart and coronary arteries. The scan quickly reveals whether the patient’s heart is normal—at which point they can be released and treated by their primary care physician—or if they are at risk of a heart attack. 30% of patients scanned do have some heart disease with 5%-to-10% needing further evaluation for critical heart disease. 60% of patients scanned have no heart disease and are discharged from the emergency room. With cardiac CT scanning in the emergency room, the patients can move from diagnosis to treatment, often going home the next day without a barrage of downstream scans and tests.”
Beyond the speed-efficiency, it is the accuracy of the cardiac CT scan that saves lives. "The greatest value of the cardiac CT triage is accuracy. We call it the negative predictive value of the cardiac CT scan,” said Dr. Turner. “The likelihood a patient with a normal scan is not going to have an event is 99.5%. There is no other test in cardiology that is that accurate. I can tell a patient their arteries are normal and that they won't have a heart attack for the next ten years and be 99.5% sure I am right. Contrast that with a stress test or a nuclear scan, which is still considered the standard of care. If you’re asking whether a patient has coronary artery disease or not, those tests are 60% to 65% accurate. That’s why you’ll often see people who have a heart attack a month after a nuclear scan that came back normal. Too many at-risk patients are missed using those methods.”
While the implementation of the cardiac CT triage is good news, there is still a long way to go, but interest is growing on an international level among cardiologists. On October 15, 16 & 17-2017, Dr. Turner will be presenting important discoveries made using the cardiac CT method to interventional & research cardiologists from the United States and Europe at the International Congress on Innovations in Coronary Artery Disease in Venice, Italy. “We’ve been using the cardiac CT triage method in emergency rooms for two-and-a-half years,” said Turner, “and we have discovered a unique subset of patients that have moderate coronary artery disease with high-risk plaque in the artery wall. The cardiac CT triage scans reveal that there is a significantly increased risk of a heart attack or chest pain event in the next year for this subset of patients. Without the cardiac CT triage scans, it is likely these risks would go unrecognized.”
“It is my passion and hope that emergency rooms across the United States will begin using the cardiac CT triage method as the new standard of care,” said Dr. Turner. “Already, Great Britain’s national health service has now mandated that a cardiac CT scan be the very first step in the evaluation of people with chest pain. Only those that have an abnormal CT scan would need further testing or treatment. They’ve done this primarily for cost issues. It benefits the hospitals and the patients. If you know that you don’t have to treat someone because they have a negative CT angiogram, then that will take a lot of people off cholesterol medicines and eliminate a lot of downstream testing.”
Looking ahead, Dr. Turner sees his influence primarily in diagnosis and prevention using cardiac CT scan analysis. “Cardiac CT continues to be my focus,” said Dr. Turner, “but our entire team of cardiologists at Cardiovascular Specialists of Southwest Louisiana are involved in other medical firsts for our area. Right now our cardiologists are spearheading the new TAVR (Trans-catheter Aortic Valve Replacement) procedure where the aortic valve is being replaced by going through the artery rather than opening the chest. We’re working with the only hospital in Lake Charles doing that procedure. This is a major program concentrating on people that are high-risk for an open valve replacement, yet desperately need that valve replaced. With this procedure, many patients go home within 24-to-72 hours.”
As they have for over 40 years, Dr. Michael Turner and the cardiologists at Cardiovascular Specialists of Southwest Louisiana continue to be on the frontline of new developments in cardiology, serving all Lake Charles area hospitals.
For more information, contact Cardiovascular Specialists of Southwest Louisiana office at (337) 493-5508 or send an e-mail to chinton@imperialhealth.com